Diet Texture Compliance Audit Checklist Form
Assess whether served foods and beverages match prescribed diet texture requirements.
Audit Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Auditor Name
*
First Name
Last Name
Facility/Unit Name
*
Meal or Service Audited
*
Please Select
Breakfast
Lunch
Dinner
Snack
Other
Prescribed Diet Texture Level
*
Regular
Soft
Minced & Moist
Pureed
Other
Observed Food Texture
*
Matches Prescribed
Softer than Prescribed
Harder than Prescribed
Other
Beverage Thickness Served
*
Thin
Nectar Thick
Honey Thick
Pudding Thick
Other
Overall Compliance Status
*
Compliant
Non-Compliant
Discrepancy Details (if any)
Corrective Action or Follow-Up
Submit Audit
Should be Empty: