Information
-
Conducted on
-
Prepared by
-
Personnel Conducting inspection
-
Clinical unit performed on:
Engineering
Engineering issues
-
Lighting is in good condition
-
Light Pull Chord in working condition
-
Plumbing in working condition
-
Ceiling tiles and tbar are clean with no stains, cracks, or missing
-
Paint is in good condition
-
Doors are in working condition including all hinges
-
Bathroom door in working order
-
Shower door in working order
-
Patient Room door in working order
-
All outlets in working order
-
Vents are in working order and are clean of debris and dust
-
Nurse Call working properly?
-
TV working properly in correlation to the Nurse Call System?
-
Are there any holes in the walls?
-
No Penetrations in the corridors or stairwell
-
All fire doors latch and close properly
-
All exit signs are properly working
-
All stairwell passage lights are working properly?
-
Are all means of egress free of obstruction both internal and external?
-
Is flooring in good condition?
Housekeeping
Housekeeping Issues
-
Floor dust/dirt free corners/edges
-
Floor under furniture dust/dirt free
-
Walls dust/dirt free including corners
-
Window ledges dust/dirt free
-
Overbed light dust/dirt free
-
Closets are dust/dirt free
-
Call light control dust/dirt free
-
Patient bed rails cleaned
-
TV set dust/dirt free
-
Bedside cabinet clean
-
Over bed table clean
-
Cubicle curtain clean
-
Air vents clean
-
Waste containers clean
-
Room is odor free
-
Restroom floor corners/edges clean
-
Restroom walls dust/dirt free
-
Toilet cleaned including around and on the bottom
-
Sink cleaned including bottom
-
Paper towel dispenser supplied
-
Soap dispenser supplied
-
Toilet paper dispenser filled
-
Hand Sanitizer is in working order and filled
-
Sharp Container is less than 3/4 full and clean
Approval
-
Approval of these rounds are accepted by:
-
Clinical Unit Director/CSM
-
Engineering Representative:
-
EVS Representative:
