Crothall Services Group - EVS Customer Rounds

• Building

• Facility

• Floor

• Room

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions
  -------------------
  1. Answer "Excellent", "Good", "Fair", "Poor" for the items below. Choose N/A if not applicable.
  2. Add photos and notes by clicking on the paperclip icon. (Specify the room number in the notes)
  3. Complete audit by providing digital signature.
  4. Share your report by exporting as PDF, Word, Excel or Web Link.

Details

• Interviewee

• Employee

• Supervisor

Customer Survey

• Rate the cleanliness of your area.

  5

  4

  3

  2

  1

• Rate the responsiveness of our staff to your requests.

  5

  4

  3

  2

  1

• Rate the availability of restroom and patient area supplies.

  5

  4

  3

  2

  1

Quality Tour Comments

• Patient Room 1

  5

  4

  3

  2

  1

• Patient Room 2

  5

  4

  3

  2

  1

• Patient Room 3

  5

  4

  3

  2

  1

• Med Room

  5

  4

  3

  2

  1

• Nurses Station

  5

  4

  3

  2

  1

• Staff Lounge

  5

  4

  3

  2

  1

• Staff Restroom

  5

  4

  3

  2

  1

• Clean Utility Room

  5

  4

  3

  2

  1

• Soiled Utility Room

  5

  4

  3

  2

  1

• Family Waiting Room

  5

  4

  3

  2

  1

• Family Waiting Room RR

  5

  4

  3

  2

  1

• Corridors

  5

  4

  3

  2

  1

• Computer Room

  5

  4

  3

  2

  1

• Elevators

  5

  4

  3

  2

  1

• Stairwells

  5

  4

  3

  2

  1

• Comments

Completion

• Signature

  Sign