IA-004-0
Republic of the Philippines
Department: Medical-Nutrition and Dietetics
Date: 10-28-19
Audit Reference
6.1 FOOD PREPARATION
AND PRODUCTION
6.1.1
6.2 DISTRIBUTION OF MEALS
& COLLECTION OF
UTENSILS
6.4 DISINFECTION AND
INVENTORY OF UTENSILS
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan
AUDIT CHECKLIST
Auditee: MS. ALICIA M. PAZZIUAGAN
Page 1 of 1
Audit Item Audit Result Remarks
The auditee was able C
to discuss step by step
How do you prepare food for the procedure on the
the patient? preparation of foods.
The auditee presented
What are the documents the necessary
needed as basis in the documents like Diet C
preparation of food for List prescribed by
patients? doctors, and the
planned cycle menu
The auditee was able
to discuss the
How do you plan menu for procedure on the
patients? planning of menu C
based on the Diet List
The auditee was able
How do you monitor the to discuss their C
distribution of meals? procedure in the
distribution.
How do you conduct inventory
of utensils? The auditee was able
to present the
procedure in C
conducting inventory of
utensils.
Present evidence as to the
distribution and collection of
utensils. Distribution and
collection of utensils
are not properly
recorded. Thus, mix OFI

How are rice being monitored?
6.5 INVENTORY OF
MATERIALS
6.5.2
Check the rice consumption
logbook
Are there monitoring of as to the
number of patients being
catered?
6.7 CONDUT OF DIET
COUNSELLING AND
NUTRITION EDUCATION
Evidence of Nutrition Education
Report being submitted to HEPO
quarterly
recording was
practiced.
Record the beginning
and ending balance of
rice consumption in the C
“Consumption of Rice
Logbook”
Beginning and Ending
balance were recorded.
However, recording of OFI
entries were NOT
updated.
Number of patients
catered are recorded in
the logbook. However, OFI
traceability of records
of patients are hardly
kept.
No date in the
KARDEX being OFI
monitored
6.7.2.3 Nutritionist
Dietician prepare &
submit number of NON COMPLIANT
clients and topics (NC)
discussed on
Nutrition Education to
health Education and
promotion Officer
Quarterly.
However, such was not
presented for the 1st to
3rd Quarter for the year
2019. Evidence
presented was only for
the 4th Quarter of year
2018.
 Not all staff are aware of
Check for the awareness of the the Quality Policy of the OFI
Quality Policy Hospital

7.1 ISO STANDARD

The preventive and
Check for the preventive
maintenance logbook was OFI
maintenance schedule and
not coded.
reports.

Prepared by: Reviewed by: Approved by:

REIA DOREEN M. RUECO ROSELLE L. VARON JANE G. PAGADDU, MD, FPSP, MBAH
Auditor Lead Auditor QMR