Information
-
Department
-
Conducted on
-
Prepared by
-
Personnel involved
-
Lights are free of dust/bugs?
-
The patient sink and toilet are clean, soap and towels are available?
-
The patient bedpans and urinals are labeled, clean and stored appropriately?
-
The window sills in the patient rooms are not cluttered and are dust free?
-
The overbed tray table is positioned by patient, is clean and clutter-free?
-
Linen has no stains and/or tears?
-
Floors are clean, free of trash and boxes on floors?
-
Housekeeping closets/carts are locked?
-
Housekeeping closets/carts are clean and chemicals are stored properly?
-
Housekeeping carts are not unattended?
-
Equipment in patient rooms is clean?
-
Patient privacy curtains are clean, hung properly, function properly, and free of defects?
-
Furniture is clean & in good repair (clinical & visitor areas)?
-
Additional Comments
