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MEAL EVALUATION

DATE: __________________

DIET:__________________________________________________

DAY: M T W TH F S SU

MEAL:_______________________________

WEEK: A B C
Score each category 1 to 5:
1 = Poor, Extremely Unsatisfied

2 = Substandard, Unsatisfied

4 = Good, Satisfied

Menu Item

Temperature

3 = Fair, Somewhat Satisfied

5 = Excellent, Extremely Satisfied

Appearance

Portion
Size

Flavor

Texture

Diet
Accuracy

Temperature Ranges:
140 -170

150 -180

160 -190

60 -70

35 -55

Entrees

Hot Cereal

Soup/Broth

Cake/Pastry

Dessert/Fruit

Starch

Cream Soup

Gravy

Hot Vegetable

Hot Beverage

Cold Salad
Cold Beverage/Milk

Comments:
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Follow-up:
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