• Dysphagia Diet Audit Form

    Use this form to audit dysphagia diet compliance, meal service quality, and swallowing safety observations for a specific resident or patient.

  • Audit Details

  • Audit Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Meal / Service Type Audited*

  • Patient/Resident and Diet Information

  • Observed Meal Compliance

  • Observed Compliance Audit Grid*
    Rows
  • Food texture compliance status*
  • Liquid consistency compliance status*
  • Safe feeding and positioning practices observed*
  • Items needing follow-up

  • Staff Communication and Safety Review

  • Staff understanding of the prescribed diet*
  • Correct meal delivered to the correct person*
  • Swallowing safety concerns observed*

  • Findings and Follow-Up

  • Issues Identified*
  • Follow-Up Status*
  • Follow-Up Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty:
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