Introduction Indian Health Service, Reno District, Environmental Health Services staff developed an initiative to assess food safety risk among home meal recipients at seven participating tribal elder nutrition programs (ENPs). Traditionally, the home delivery process could significantly increase the risk of foodbome illness if inappropriate practices were being followed. Methods: The initiative included two assessment phases. The first assessment phase consisted of identifying food safety risks during the home delivery meal process and other operational issues related to the ENP. The second assessment involved administering a questionnaire to participants of the ENP in an effort to obtain information regarding elder food safety knowledge, attitudes, and practices. Results: Eleven delivery processes, representing 7 ENPs, were assessed and had an average delivery time of 1.6 hours. Twenty-five potentially hazardous foods (PHFs) were monitored. By the end of delivery, 76% of PHFs were below the hot holding temperatures recommended by the Food Drug Administration. Fourteen critical control point (e.g., point or procedure in a food system at which a control can be applied and a food safety hazard prevented) failures were identified and included such deficiencies as failure to check and document final cooking temperatures (100%), failure to monitor the temperature of food received from a food distributor (100%), failure to monitor and document food temperatures during delivery (86%), and failure to monitor food temperatures after food purchase and transport (80%). Also, 29% of the ENPs were entering homes to leave meals when clients were away and 29% of the ENPs routinely left meals outside the client's home in a cooler or milk crate. One hundred and seventy eight questionnaires (51% return rate) were completed. Findings revealed that 27% do not eat their meals immediately upon receipt, 23% had their meals left outside, and 13% had their meals left on the kitchen counter. Also, 93% of elders were unable to identify foods to avoid to reduce food safety risk. Conclusion: Based on the site assessments, ENPs should implement and adhere to standard operating procedures to address critical control points in their processes. They should also purchase the Nutri-System thermal bags, recently available on the market, as they can maintain 185° F during transport. Meals should not be left at the client's door or inside the home when the client is not at home. Rather a backup plan (i.e., support network) should be available and food safety education should be provided to all. In addition, further studies should be conducted with an emphasis on what happens to the meal once delivered.