Audit

PATIENCE ROOMS
Patient Room 1

PT. Room #

1. Overbed Table Cleaned?

2. Night Stand Cleaned?

3. Phone Cleaned?

4. T.V Cleaned free of Dust?

5. Picture Frame free of Dust?

6. Overbed Light Cleaned free of Dust?

7. Closet Cleaned?

8. Walls Cleaned?

9. Vents Cleaned free of Lint?

10. Ceiling Cleaned?

11. Door Cleaned?

12. Door Handle Cleaned?

13. Door Frame Cleaned?

14. Waste Can Cleaned?

15. Floors Cleaned?

16. Cubicle Curtain Cleaned?

17. Cubicle Curtain Functional?

18. Room Organized?

Patient Room 1

PT. Room #

1. Overbed Table Cleaned?

2. Night Stand Cleaned?

3. Phone Cleaned?

4. T.V Cleaned free of Dust?

5. Picture Frame free of Dust?

6. Overbed Light Cleaned free of Dust?

7. Closet Cleaned?

8. Walls Cleaned?

9. Vents Cleaned free of Lint?

10. Ceiling Cleaned?

11. Door Cleaned?

12. Door Handle Cleaned?

13. Door Frame Cleaned?

14. Waste Can Cleaned?

15. Floors Cleaned?

16. Cubicle Curtain Cleaned?

17. Cubicle Curtain Functional?

18. Room Organized?

PATIENT RESTROOM
Patient Restroom 1

1. Toilet Bowl Cleaned?

2. Sink Cleaned?

3. Shower Cleaned?

4. Shower Curtain Cleaned?

5. Shower Curtain Functional ?

6. Supplies In Place?

7. Floors Cleaned?

PATIENT RESTROOM
Patient Restroom 2

1. Toilet Bowl Cleaned?

2. Sink Cleaned?

3. Shower Cleaned?

4. Shower Curtain Cleaned?

5. Shower Curtain Functional ?

6. Supplies In Place?

7. Floors Cleaned?

WAITING ROOM / Public Restroom

Location:

Overall condition of the waiting room cleaned?

Location:

Overall condition of the public restroom cleaned?

ANCILLARY AREA
Ancillary Area 1

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

Ancillary Area 2

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

FLOORCARE
Floorcare 1

Location:

1. Baseboard Cleaned?

2. Corners Cleaned?

3. Edges Cleaned?

4. Floors Finished / Carpet Clean?

Floorcare 2

Location:

1. Baseboard Cleaned?

2. Corners Cleaned?

3. Edges Cleaned?

4. Floors Finished / Carpet Clean?

ENVIRONMENTAL ROUNDS
Personal Protective Equipment

1. Gloves?

2. Eye Goggles?

Chemical

1. Disinfection wipe container lids closed and labeled correctly?

2. Chemical Dispensing unit in working condition?

3. Disinfectant Wipe/bottle properly Dated?

Hopper Closet

1. Closet cleaned & organized?

2. Eye Wash Station Clean & Checked?

3. Work Charts Available?

Stairwell/Elevator

Location:

1. Elevator Tracks / Door Clean?

Location

2. Stairwell Clean free of Dust/Litter?

3. Stairwell Ledges / Handrails Clean?

4. Housekeeping Cart Clean & Orderly?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.