Daily Lead Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Your Staff

• 1. Did you inspect if your staff are wearing they're assigned EVS uniform

  Yes

  No

  N/A

• 2. Did you inspect if your staff have their badge?

  Yes

  No

  N/A

• 3. Did you pass out all assigned checklist to your staff?

  Yes

  No

  N/A

• 4. Check YES if compliant. Does TDS need to be called to haul the dumpster<br><br>512-421-1340

  Yes

  No

  N/A

• 5. Check YES if compliant. Are there 12 bails of cardboard or more? If so, TDS needs to be called to haul it off. Document pickup.<br><br>512-421-1340

  Yes

  No

  N/A

• 6. Did you inspect staff washing there hands? How many did you inspect and what were the results?

  Yes

  No

  N/A

• 7. Did you inspect the OR log? Did you check the weekend as well? <br><br>Please follow up daily to ensure compliance.

  Yes

  No

  N/A

• 8. Did you inspect the Periodic Cleaning Record Log?<br><br>Please follow up daily to ensure compliance

  Yes

  No

  N/A

• 9. Did you check supplies? Do we need to order anything?

  Yes

  No

  N/A

• 10. Did you inspect dock for new supplies waiting to be received and stored?

  Yes

  No

  N/A

• 11. Do we have legacy linen?<br><br>Please follow up daily to ensure compliance

  Yes

  No

  N/A

• 12. Did you check your teams equipment for floor care to make sure it was clean and operational?

  Yes

  No

  N/A

• 13. Did you sign the manifest for bio hazard pickup?

  Yes

  No

  N/A

• 14. Are all the housekeeper vacuum cleaners clean and stored in the equipment room?<br><br>Please follow up daily to ensure compliance<br>

  Yes

  No

  N/A

• 15. Did you inspect your teams housekeeping carts? Does anything need to be replaced?<br><br>Please follow up daily to ensure compliance

  Yes

  No

  N/A

HCAHPS

• 1. Did you perform 3 patient interviews

  Yes

  No

  N/A

• 2. Did you inspect 5 discharge rooms today

  Yes

  No

  N/A

• 3. Did you complete 5 EVS inspections

  Yes

  No

  N/A

Did you inspect these hot spot areas?

• HOT SPOTS- phones, bedside table, bed rails, keyboards, remotes, door handles, dispensers, furniture.

• 2nd Shift - did you inspect Radiology?

  Yes

  No

  N/A

• 2nd Shift OR - did you inspect the OR Rooms and Equipment? - weekly floor scrubbing as well

  Yes

  No

  N/A

• 2nd Shift - did you inspect ED Rooms?

  Yes

  No

  N/A

• 1st Shift - did you inspect 4 Med Surg - Rooms & Areas?

  Yes

  No

  N/A

• 2nd & 1st Shift - did you inspect Public Restrooms?

  Yes

  No

  N/A

• 1st Shift - did you inspect L&D?

  Yes

  No

  N/A

• 1st Shift - did you inspect 3rd flr & 2nd flr pharmacy- checking to see if someone signed the log?

  Yes

  No

  N/A

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