Environmental Cleaning Audit

• Functional Area

• Room / Area Name
  Address

• Conducted on

  Date

• Auditors

Building

• External fixtures, fire exits,stairwells

  Yes

  No

  N/A

• Walls, skirtings

  Yes

  No

  N/A

• Ceilings, high areas, curtain rails

  Yes

  No

  N/A

• Windows

  Yes

  No

  N/A

• Doors, door frames

  Yes

  No

  N/A

• Hard floors

  Yes

  No

  N/A

• Soft floors

  Yes

  No

  N/A

• Ducts, grills, vents

  Yes

  No

  N/A

• Comments

• Pictures

  Media

Fixtures

• Electrical fixtures, desk appliances

  Yes

  No

  N/A

• Furnishings, fixtures

  Yes

  No

  N/A

• Kitchenette fixtures, appliances

  Yes

  No

  N/A

• Toilets, bathroom fixtures, sinks

  Yes

  No

  N/A

• Comments

• Pictures

  Media

Patient Equipment

• Medical equipment

  Yes

  No

  N/A

• Patient bed

  Yes

  No

  N/A

• Oxygen, suction connectors, wall mounts

  Yes

  No

  N/A

• Patient furniture

  Yes

  No

  N/A

• Comments

• Pictures

  Media

Environment

• Waste recepticals

  Yes

  No

  N/A

• General tidiness

  Yes

  No

  N/A

• Odour control

  Yes

  No

  N/A

• Comments

• Pictures

  Media

• Signature

  Sign