Title Page
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Conducted on
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Prepared by
Areas Toured/Complaints:
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Areas Toured?
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Complaints?
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Has complaints been resolved?
Discharge Information:
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Number of beds left from previous shift?
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Daily response time?
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Daily turnover time?
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Current census?
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Number of beds passed over to next shift?
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Contact isolation curtain change?
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Any Discharge Issues?
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Has The discharge issues been resolved?
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Additional work passed on to next shift?
Trash Chute & Carts (Cleared & Cleaned)?
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Queeny Tower
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West Pavilion
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Peters
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East Pavilion
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Any trash issues?
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Has the trash issues been resolved?
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Time compactor picked up?
Public Restroom Terminal Cleaning:
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South Main Level:
- Mens
- Women's
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South Street Level:
- Mens
- Women's
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North CAM 1st Floor:
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North CAM 3rd Floor:
- Mens
- Women's
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North Garage:
- Mens
- Women's
Staffing: Call offs/Late ins & issues:
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BJH Staff: Call off /Late ins
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MWS Staff: Call offs/Late ins
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Staffing issues?
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Has staffing issues been resolved or need further investigation?
Projects / Other Info / Bed Depot:
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Projects Completed:
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Bed Depot Status:
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Other Info:
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PM Rooms:
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Staffing / Visitor Injuries:
Customer Touch base:
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Touch base with in the (OR)?
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(OR) Comments:
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Touch base with in the (ED)?
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(ED) Comments:
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EMG 3 Check:
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(EMG 3) Comments: