Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Blue Prints

  • Get the blue prints for the building for SmartFacility software upload or by job costing.

  • Get the floor types for the floor care program (carpet, no wax, wax, ceramic, etc.)

Building Integrations

  • Send info to the entire building about cleaning vendor changes.

Access Database (M Drive)

  • Request Database Coordinator creates building/team specific access database.

  • Database Coordinator enters employee info as hired.

Info on Employee Spreadsheet

  • Employee lockers - create a spreadsheet for the locker #s and lock combinations.

  • Employee keys - create a spreadsheet for key sets and what each employee has.

  • Employee communication devices - create a spreadsheet for any devices issued to employees.

Keys for staff/management

  • Dispensers keys needed.

  • Door keys needed.

  • Trash compactor keys needed.

  • Recycling compactor keys needed.

  • Haz Waste and RMW room keys needed.

  • Department lock box / key rack / or 1 set per person?

  • Janitor closet key sets available?

  • Master keys for management.

  • Train staff to keep keys in lockers or turn in each shift

  • Get badge access for all applicable doors.

  • Get door codes for all applicable doors.

  • Make a quick tip sheet for staff for the door codes.

  • Parking for staff

Alarm Codes for Building Access

  • Who is the alarm vendor? Contact name and phone number.

  • Alarm card for ES staff with scripting

  • How many alarms in the building and their coverage area?

  • How are the alarms activated? (motion, door)

Communication tools

  • Will we be using pagers?

  • Will we be using Ascoms?

  • Will we be using an iPhone?

  • Personal cell with stipend?

  • Will we be using walkie talkies?

  • Gather list of contact names/numbers of building management.

  • Find out the owners of the building meeting calendars and as for an invite to share that calendar for standing meetings..

  • Get the email group for this building.

  • Create communication log/binder for offsites.


  • Roll out dress code policy

  • Change to SHGR uniforms

  • Who pays for the uniforms?

Department Specific - Meet with each department

  • Find out what days/hours they are open

  • Current services - desks, phones, computers?

  • Explain any differences they may need to adapt to with switching cleaning services.

  • What equipment do we clean can we integrate the SHGR process for patient rooms?

  • What known past issues have they experienced or common complaints?

  • IS - Do we clean communication closets?

  • NS - Do we clean anything in the kitchen or dining area?

  • FSS - Do we clean their work areas?

  • FSS - Do we clean electrical closets?

  • FSS - Who cleans the vents?

  • FSS - Do we have a work order system?

  • Morgue - how do we get notified of a case?

  • Emergency Preparedness - codes for the building


  • Who cleans in between cases?

  • What time does OR start and end?

  • How many times is trash picked up in the OR area?

  • Test current OR with ATP

  • How do they handle the total joint cleanings?

  • Does the OR need anything special in their area?

  • How many surgeries per day average?

  • How many admits per day?

  • Who reports out the daily census?

Emergency Department

  • Who cleans in between patients?

  • What is the best time for terminal cleans in the ED?

  • How many trash pulls are needed?

  • Cleaning frequency of restrooms

  • Cleaning frequency of exam rooms

Labor and Delivery

  • Who cleans the C-section room?

  • Who cleans the baby warmers?

  • Who cleans the bassinets?


  • Average census for the day?

  • Average discharges for the day by time frames?

  • Where do we get daily census report?

  • Is there software to initiate a discharge call to ES when the patient is discharged from the nursing software?

Frequency for room cleaning

  • Restrooms 3-5 times in 24 hours. Time study area.

  • Lobby 3-5 times with 1 terminal clean on 2nd shift when they close.

  • Waiting rooms - evaluate if they close and usage.

  • Personal offices - 1 cleaning per week with 2nd trash pull (unless contract is paying ES to clean more)

Frequency of floor care

  • Create a spreadsheet with each room and floor type.

  • Complete time analysis on how long floor is good until we need to do again.

  • Create floor care calendar.

Assignment Sheets

  • Use SmartFacility software to load every room in the facility

  • Create assignment sheets by time available

  • Train staff on how to use as a roadmap and document on these

  • Arrange files in office to house archived sheets for 3 months. Surgery and long term care for 1 year.

  • Use standard D/C sheet for state run areas.

  • Use standard complete sheet for state run areas - track in database to assure all rooms are completed each month.

  • Assign break times for continuous floor coverage - what is building standard break time variations?


  • What are the average discharges per 24 hours? Per shift?

  • Do you have enough people to cover discharges?

  • Evaluate and consider extra staffing for the start-up and or construction clean up.


  • What is our cost center and account lines?

  • What are the current costs for the ES budget?

  • Break down costs by vendor

  • What are any offsite/dr offices costs? Who pays for consumables? Who delivers them?

  • Who cleans leased spaces? Who pays for it and how?


  • Who places orders? cleaning supplies and offices supplies

  • What are the delivery days? Is there a way to save on deliveries fees by going to once a week?

  • What order system is being used?

  • Does Supply Chain do par levels and ordering of standard supplies?

  • If ES does ordering - make an inventory sheet with product name, numbers, and par levels and arrange in order of stockroom order.

  • Make sure we have correct Lawson numbers so the order comes to the correct building.

  • How do we get our supplies from the dock?

  • Get previous supplies averages to base future orders from


  • Who pays for the patient unit stock?

  • What trash can liners do they use and par levels?

  • What linen liners do they use and par levels?

  • Who pays for small red bags?

  • What size wax liners do they use for the women's RR and par levels?

  • What paper toweling do they use and par levels?

  • What toilet paper do they use and par levels?

  • What soap do they use and par levels?

  • What sanitizer do they use and what par levels? Who pays for sanitizer? Who stocks it?

  • Count all dispensers and containers for new building opening order (soap, liners, sanitizer, toweling)

  • Try to change all dispensers to one model if there is money to standardize.

  • Where do sharps containers come from?

Cleaning Chemicals

  • Audit chemicals in house

  • Switch to SHGR standards

  • Install 3M Twist N Fill system

  • Get rubber hosing installed on the over fill valve so employees are not sprayed.

  • Assure all chemicals are in the SDS Vault

  • Remove spray triggers except window cleaner

  • Get lids for the quat buckets

  • Get yellow buckets for quat and blue buckets for bleach.

  • Set up titration testing


  • Evaluate equipment needs. Find out storage space, measure and assure what you order will fit. Use the standard equipment checklist.

  • Order equipment in advance (1-2 months) to a staging area.

  • Assess how many cleaning carts/brutes you will need.

  • 6S the cleaning carts according to SW

  • Eyewash bottle on every cart

  • Where are the eyewash stations on the units? - educate staff

  • Evaluate if flatbed carts are rusted or wooded. Replace with Rubbermaid for infection prevention purposes.

  • Number each piece of powered or wheeled equipment.

  • Create a spreadsheet for the numbered equipment that shows parking spot, asset tag number (if applicable) and repairs column.

  • Order goggles for staff

  • Washer and Dryers - what do we wash? Is it sufficient for infection prevention (c-diff, etc.)


  • Matting - who owns/services/cost?

Wheelchair Cleaning

  • Who cleans wheelchairs? If ES - use Fuller SW

Clinical Equipment

  • Who cleans clinical equipment? Try to set up the same as the SHGR SW system

  • Bed moving process - What is the process and when does cleaning occur?


  • New hire training program the same as SHGR

  • Have current mgmt. go to the entity specific orientation to learn the aspects of the new building

  • Train all staff on cleaning using the SmartFacility steps and SW

  • Train all techs to use brutes

  • Do they use chutes or dumpsters in closets for waste?

  • Cross train teams - Laundry/cleaning tech/floor care

  • Train staff where to use chemicals for requirements and cost saving.

  • Train all staff to lock and secure cleaning carts with chemicals for lunch/break times

  • Freight elevator training

  • Are the LARA signs posted updated?

  • IV Room competency program - binder, employees trained, sign off sheets, designated equipment

  • Create a quick tip tool for different styles of beds/stretchers to make

  • Create an offsite mgt staff reference book for assignment sheets, time clock locations, and API codes.

Quality Program

  • Use Smart Facility software system in conjunction with SW for qualities

  • Train employees on the SW for qualities including reporting.

  • Train mgt on SW expectations in the mdrive.

ES Handbook

  • See if additions to the building specific page need adjusting before rolling out to the staff.

  • Roll out to employees and train. Have them sign off on signature sheet.

Human Resources

  • Policies on attendance, professional conduct

  • Integrated disability management contact name

  • Generalist contact

  • Payroll contact

  • Recruiter contact

  • Progression on performance correction path - Who needs to approve? / Who needs to attend?

  • Requisition submitting format - Who fills out? Who approves? Non competes? Stagger large groups.

  • Verification of driver license process for driving SH owned vehicles.

  • Liability of having staff clocked in when traveling.

Work orders for ES

  • Use 1-help if possible with monitor in break room - use ES email system if not available

  • Set up TMS work order pager

Transfer of patient/resident process

  • Treat like a D/C - clinical staff moves all personal items and furniture - ES cleans

Dirty Briefs

  • Placed in trash can liner holder in each room with a bag of liners for nursing to use. Educate clinical on proper procedure to place brief in bag. Tie off and bring to soiled utility.

30 Day Complete Cleaning Process

  • Employees use SW sheet for 30 day clean and turn into Supervisor

  • Mgt to track on spreadsheet each month to assure all beds are being cleaned every 30 days.


  • Create a spreadsheet with each room with a pyxis on a weekly schedule


  • Who cleans fans? If ES, put on assignment sheet for once a week.

Lost and Found

  • Lost and Found - Who is the owner? What is the process? If ES, follow Pennock SW


  • Who is the vendor? How often do they clean? What is the cost? Can we get it for a better cost?

Pest Control

  • Who is the vendor? What are the costs? When do they service? Is ES or FSS the contact for them?


  • Evaluate all public waiting spaces and patient areas for needs.


  • What are the current ES Policies? Laundry policies? What can we integrate for the SH ES policies? What are the current Haz Mat/RMW policies?

RMW / Haz Waste / Recycling

  • RMW - Who is the vendor? What is the pricing? When is the contract up? What is the pick-up frequency? What's included in the price? (liners) Are there minimum fees or location fees?

  • Who packages and transports the RMW to the storage areas? Are they trained?

  • Who orders and stocks new sharps containers?

  • Haz Waste / Rx Waste - Is there a program? Who is the vendor? Who pays for this program?

  • Who packages/transports the Haz Waste / Rx waste? Are they trained?

  • Who packages/transports Universal waste?

  • Who is in charge of record keeping for waste?

  • Who is the vendor for recycling? Shredding?

Storage Areas

  • Waste Room meets requirements? - Proper signage on all rooms? No open floor drain? All containers are dated properly? 6S storage area.

Licenses/Manifest/Record Keeping

  • Get the RMW DEQ certificate. Make sure it is current and accurate. Large Quantity Generator or Small Quantity Generator? Send copy to SHGR Safety Officer.

  • Organize all manifests for past 3 years following the SW in the mdrive.

  • Send in hazardous waste copies to the DEQ for the past 1.5 years if they haven't already been sent in.

  • Train all employees that will sign and those that have signed manifests for the past 3 years using the DOT training on the mdrive.

  • Get all room numbers for waste storage for the transporters task sheet.

  • Nursing and RMW - Evaluate storage areas (signs, locked, no drain) , train nursing if needed.

  • Batteries - Room numbers, frequency, green buckets, training, memo, signage, Vendor.

  • Spent Oil - location, labeling, date, documentation

  • Spent Lightbulbs - location, labeling, date, documentation

Trash Waste

  • Who is the vendor? Who pays for it? What is the frequency?

  • Are there any other waste streams such as electronics? Metal? Grease? Composting?

Office Set-Up

  • Where is the ES office? Set up paper/pen products needed. If furniture needed, get ahold of ES project manager for warehouse furniture.

  • Create employee files in locked cabinet. Create payroll adjustment binder in locked area. Create employee log for concerns in locked area.

ES Storage Set-up

  • Identify all ES space. Do we need shelving? 6S the spaces - heaviest stock on bottom.


  • Who runs the laundry program? Who is the vendor? What are the costs? What is the frequency?

  • Are there extended cart use fees? Are gait belts owned by the facility? Can we eliminate any laundry items?

  • If switching to WMSHL, give 2 months heads-up with pars.

  • 6S laundry areas

Personal Laundry

  • Place bins on each unit. Wash and return articles daily. Label all clothes. Lost article slips reviewed and closed out in 24-48 hours. Follow RNCK SW.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.