EVS - Patient Visitation / Cleanliness Evaluation 2018

• Division:

• Housekeeper Assigned to Area:

• Room Number:

• Conducted on:

  Date

• 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.

Patient Satisfaction Questionnaire:

• Have you seen your housekeeper today?

  Yes

  No

  N/A

• Did the housekeeper explained to you what they'll be doing?

  Yes

  No

  N/A

• Was your room & restroom cleaned and disinfected today?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Script:
  Do you mind if I conduct a visual observation of your room?

EVS Visual Observation

• Does the overall cleanliness of the room meet satisfactory condition? (Floor, Walls, Ceiling, Furniture, Waste-cans, Cubical Curtain)

  Yes

  No

  N/A

• Does the overall cleanliness of the restroom meet satisfactory condition? (Tub/Shower, Toilet, Sink, Mirror, Floor, Walls, Ceiling, Waste-Can, Shower Curtain)

  Yes

  No

  N/A

Areas for Improvement

• Nursing?

  No

  Yes

• Facilities Engineering?

  No

  Yes

• Food & Nutrition?

  No

  Yes

• Environmental Services?

  No

  Yes

• Final Scripting:
  I would like to thank you for sharing your input 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?