FoodandNutritionSurvey_10-0498.pdf
PDF 181 KB Posted
- Attached to
- M1FD--Anchorage Full Food Service Domiciliary
- Solicitation number
- 36C26023Q0816
About this file
This document contains a patient satisfaction survey for a Department of Veterans Affairs nutrition and food services program. The survey collects feedback on various aspects of the food such as taste, appearance, variety, temperature consistency, timing of meals, and staff courtesy. It also asks patients to rate their overall satisfaction and provide any additional comments.
The related federal contract opportunity is a solicitation by the VA Veterans Health Administration for full food service operations at the Anchorage Domiciliary. Offerors are to provide all management, personnel, equipment, supplies and other items necessary to perform dining facility food services for residents. The solicitation includes requirements for menu planning, food preparation and service, staff training, and quality control. The place of performance is the VA Alaska Healthcare System campus in Anchorage, Alaska.
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Text version
OMB
2900-0770 Estimated Burden: 2 min.
Nutrition & Food Services Satisfaction Survey “Because We Care”
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of this Act. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 2 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form.
The purpose of this data collection is to determine the level of patient satisfaction and quality of service. Response to this survey is voluntary and failure to participate will not affect any benefits to which you may be entitled.
Great Nutrition……….America’s Healthy Choice VA Form 10-0498 NOV 2012
Nutrition & Food Services
Strongly
Agree
Agree
Neutral
Disagree
Strongly Disagree
My meals taste good.
My meals look good.
My meals offer variety.
Cold food is served cold enough.
Hot food is served hot enough.
My meals are served in a timely manner.
Nutrition employees are polite and courteous.
I understand my prescribed diet.
My overall rating of Nutrition and Food Services excellent.
is
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
Comments or Suggestions?
(optional information)
Name: Room#
File details come from the government source that posted it. Updated .