Title Page

  • Conducted on

  • Prepared by

Areas Toured/Complaints:

  • Areas Toured?

  • Complaints?

  • Has complaints been resolved?

Discharge Information:

  • Number of beds left from previous shift?

  • Daily response time?

  • Daily turnover time?

  • Current census?

  • Number of beds passed over to next shift?

  • Contact isolation curtain change?

  • Any Discharge Issues?

  • Has The discharge issues been resolved?

  • Additional work passed on to next shift?

Trash Chute & Carts (Cleared & Cleaned)?

  • Queeny Tower

  • West Pavilion

  • Peters

  • East Pavilion

  • Any trash issues?

  • Has the trash issues been resolved?

  • Time compactor picked up?

Public Restroom Terminal Cleaning:

  • South Main Level:

  • South Street Level:

  • North CAM 1st Floor:

  • North CAM 3rd Floor:

  • North Garage:

Staffing: Call offs/Late ins & issues:

  • BJH Staff: Call off /Late ins

  • MWS Staff: Call offs/Late ins

  • Staffing issues?

  • Has staffing issues been resolved or need further investigation?

Projects / Other Info

  • Projects Completed:

  • Other Info:

  • PM Rooms:

  • Staffing / Visitor Injuries:

Bed Depot:

  • Clean Beds?

  • Add media

  • Dirty Beds?

  • Add media

  • Broken Beds?

  • Add media

Cubical Curtian Status:

  • Simply 66 (Snap)?

  • Mesh?

Customer Touch base:

  • Touch base with in the (OR)?

  • (OR) Comments:

  • Touch base with in the (ED)?

  • (ED) Comments:

  • EMG 3 Check:

  • (EMG 3) Comments:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.