Title Page

  • Conducted on

  • Prepared by

  • Room #

  • Type of Cleaning Request?

  • Rate cleanliness of room after case?

  • Number of EVS staff cleaning the room?

  • Time nursing entered the room into TeleTacking System as dirty?

  • Time Patient exited the room?

  • Time EVS logged into TeleTracking for cleaning?

  • Time EVS logged out of TeleTracking for completion of between case cleaning?

  • Did nursing assist in cleaning of room?

  • Comments:

  • Total Turn-Over Time?

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.