In Ghana, 77% of traceable foodborne diseases results from improper handling in Food Service Establishments (FSE). The FSE Inspection surveillance system instituted by the Food and Drugs Authority (FDA) in 2010 inspects and license FSEs to ensure compliance to Good Hygienic Practices (GHP). We evaluated the FSE Inspection surveillance system to assess if the systems objectives were being met and to assess attributes and usefulness of the system. We evaluated the FSE surveillance system by interviewing 20 stakeholders in the Greater Accra Region (GAR) using a semi-structured questionnaire adapted from the Centre for Disease Control and Prevention updated guidelines for evaluating health surveillance systems. We reviewed systems records from 2017 to 2019 and made observations of surveillance activities. Microsoft excel was used for collation and analysis of data into frequencies and proportions and results were presented in tables and graphs. From 2017 to 2019, 36.5% (876/2400) FSE applications were received with 1206 inspections carried out within the evaluation period. About 14.8% (355/2400) FSE's accepted the system with 12 out of 16 Metropolitan, Municipal and District Assemblies (MMDA's) represented in the surveillance system. Overall, sensitivity was at 60.5% with (530/876) of FSEs issued with a food hygiene permit (FHP). System restructuring or modifications barely affected the operational procedures. Timeliness was 54.3% (38/70) with almost half of FSEs inspected after the 40 days benchmark. Data completeness was 93.8% (333/355) for stored data. The FSE inspection surveillance system was found to be useful in meeting its set objective of ensuring FSE compliance to GHP. The system was flexible, stable and sensitive but was not acceptable, fairly timely and had a poor representation in GAR. Introduction of an electronic application or web-based inspections and strengthening of collaboration among stakeholders are key to improving the systems timeliness and representativeness respectively. •The Food service establishments (FSE) surveillance system in Accra was assessed.•FSE inspection is useful for improvement of food safety management systems.•Almost half of FSE's were inspected after the 40-day benchmark.•The FSE Surveillance system is flexible, stable and sensitive.•The FSE Surveillance System was poorly representative and not acceptable.