Title Page

  • Location/Room #

  • Conducted on

  • Manager Conducting Audit

  • EVS Staff Member Assigned

Door Surfaces

  • Frames and Top Edges

  • Push Plates and Handles

  • Hinges

Walls/Wall Hangings

  • Light Switches

  • Pictures/Frames

  • TV/Bracket

  • Clocks

Ceilings

  • Lights Clean

  • Vents are clean and free of dust on outsides

  • No visible spots on Ceilings/Tiles

Horizontal Surfaces

  • Counters

  • Ice Machines

  • Shelves/Cabinet Tops - free of dust

  • Fire Strobe Lights/Exit Lights - Free of dust

  • Phone and Cord - Clean and Organized

  • Railings and Ledges - Free of Dust

Windows

  • Glass Doors

  • Windows - No Smears

  • Window Sills

  • Mirrors - No Marks

  • Blinds/Curtains - No Spots

Furniture

  • Chairs/Sofas clean including the legs

  • Tables and Legs

  • Lamps/Shades

  • Garbage Cans - Clean, Extra Bags and Relined

Floors

  • Floors are clean

  • No build up in corners

  • Baseboards are Clean

  • Carpet free of debris and spots

  • No dust bunnies behind doors or equipment

MISC.

  • Hallway Sinks Clean

  • Employee Signature when Available:

  • Manager conducting Audit

  • COMMENTS:

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