Clayfield House Level III Supported Accommodation Facility

• Document No.

• Audit Description

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Clayfield House Room Audit

• Auditors Information

  Off

  On

• Name:

• Position / Title:

• Signature of Auditor: (type name here then press Tap To Sign) Tap to Sign >

  Sign

• Witness Signature:

  Sign

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Furniture:

• This section refers to Bedroom furniture purchased and owned by Clayfield House. I.e. wardrobe, chest of drawers, bedside table etc.

• Clayfield House Room furniture: START

  Off

  On

• Does the Furniture belong to CHSA?

  Yes

  No

  N/A

• Note Name of owner and furniture items they own.

• Is the furniture in good working condition? Clean? Functional?

  Yes

  No

  N/A

• Describe what items need replacing, repairing or cleaning?

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No Double adaptors

  Yes

  No

  N/A

Ensuite:

• Ensuite: Start

  Off

  On

• Toilet cistern working, no leaks, no repairs required?

  Yes

  No

  N/A

• Toilet bowl clean, no damage, in working order?

  Yes

  No

  N/A

• Shower Head in good working order? <br>Shower Walls, Curtains and accessories in good working order?

  Yes

  No

  N/A

• Lights and power points working and undamaged?

  Yes

  No

  N/A

• Walls clean and undamaged?

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Furniture:

• This section refers to Bedroom furniture purchased and owned by Clayfield House. I.e. wardrobe, chest of drawers, bedside table etc.

• Clayfield House Room furniture: START

  Off

  On

• Does the Furniture belong to CHSA?

  Yes

  No

  N/A

• Note Name of owner and furniture items they own.

• Is the furniture in good working condition? Clean? Functional?

  Yes

  No

  N/A

• Describe what items need replacing, repairing or cleaning?

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Ensuite:

• Ensuite: Start

  Off

  On

• Toilet cistern working, no leaks, no repairs required?

  Yes

  No

  N/A

• Toilet bowl clean, no damage, in working order?

  Yes

  No

  N/A

• Shower Head in good working order? <br>Shower Walls, Curtains and accessories in good working order?

  Yes

  No

  N/A

• Lights and power points working and undamaged?

  Yes

  No

  N/A

• Walls clean and undamaged?

  Yes

  No

  N/A

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A

Clayfield House Room Audit

• Add Room Number:

Doors, Locks and Latches:

• Doors, Latches, Locks: START

  Off

  On

• Door lock working and undamaged

  Yes

  No

  N/A

• Hand wash Basin undamaged and in working order?

  Yes

  No

  N/A

• Door in working order, undamaged, clean?

  Yes

  No

  N/A

Walls, Floors and Windows:

• Walls, Floors and Windows

  Off

  On

• Walls clean and un-damaged

  Yes

  No

  N/A

• Floors and floor coverings clean, undamaged?

  Yes

  No

  N/A

• Windows and window coverings: Clean, undamaged and in working order?

  Yes

  No

  N/A

Bed frame, Mattress, Protectors, Linen

• Bed frame, Mattress, Protectors, Linen. START

  Off

  On

• Bed frame in good condition, clean from dust and dirt?

  Yes

  No

  N/A

• Mattress Undamaged? Free of Stains? Or Needs Replacing?

  Yes

  No

  N/A

• Mattress protectors, pillow and linen in good order? Clean free of stains?

  Yes

  No

  N/A

Electrical Appliances:

• Electrical / Electronics Power: START

  Off

  On

• Electrical appliances have Tag n Tested label Current?

  Yes

  No

  N/A

• Lights, Light switches clean and working?

  Yes

  No

  N/A

• No double adaptors

  Yes

  No

  N/A