ED Room HRO - Revised*

• Campus Location

• Conducted on

  Date

• Prepared by

• Employee Name:

• Room Location:

• Date Marked:

  Date

• Time Marked:

  Date

• Cleaning Type

  Daily

  Discharge

• Date Inspected:

  Date

• Time Inspected:

  Date

Yes = Completely Removed / No = Appeared Untouched

• 1. Light Switch

  Yes

  No

  N/A

• 2. Door Handle

  Yes

  No

  N/A

• 3. Overbed Table

  Yes

  No

  N/A

• 4. Exam light / Monitor

  Yes

  No

  N/A

• 5. Telephone / Call light

  Yes

  No

  N/A

• 6. Chair in room

  Yes

  No

  N/A

• 7. Sink Faucet Handle

  Yes

  No

  N/A

• 8. Toilet Faucet/handrail/handhold

  Yes

  No

  N/A

• 9. Toilet Seat

  Yes

  No

  N/A