• Division:

  • Housekeeper Assigned to Area:

  • Room Number:

  • Conducted on:

  • Prepared by:

  • Script:
    Hello, My name is:____________________________, I am the, ________________________ of Environmental Services Department here at Barnes-Jewish Hospital. Our Department’s Goal is to deliver the Highest level of cleanliness and excellent customer service to our patients and there family members. If this is a convenient time for you, would you be willing to take a few moments and share with me your impression and experience of our service delivery.


  • Have you seen your housekeeper today?

  • Was your trash emptied today?

  • Was your floor mopped today?

  • Was your restroom cleaned and disinfected today?

  • Did your housekeeper ask if there's anything I can do before I leave?


  • Nursing?

  • Facilities Engineering?

  • Food & Nutrition?

  • Final Scripting:
    I would like to thank you for sharing your observations with me. We will use this valuable feedback to improve the quality of service we deliver to our patients and there family members. Before I go, is there anything I can do for you?

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.