GO DIGITAL TODAY Convert your paper checklists into digital forms
Scan this QR code to use this paper checklist on your smartphone or tablet. Visit www.iauditor.com
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?
Total Turn-Over Time?
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.
Still haven't found the checklists you were looking for?