To assess food safety program performance, the Tennessee Department of Health conducted food service surveys of randomly selected establishments and reviewed routine inspection reports by environmental health specialists (EHSs) of the same facilities. The individual restaurant sanitation scores, along with types and frequencies of violations noted by the survey team, were compared with records from the previous year. In addition, EHSs were observed as they each performed two routine inspections. Survey team staff consistently marked more critical violations than did field EHS staff. Differences between survey teams and field EHS staff in marking critical violations were statistically significant for all 10 critical violations in the first review cycle, 8 in the second cycle, and 7 in the third cycle. Over the course of the review period, there was a small but measurable improvement in scoring by field EHS staff. Marking of critical violations increased, sanitation scores decreased, and discrepancies with survey teams in both areas decreased.