Inspection

Door Surfaces

Frames and Top Edges

Push Plates/Handles

Hinges

Walls and Wall Hangings

Pictures/Frames

Plastic Chair Rails around the Room

Dry Erase Board

Light Switches

TV/Bracket

Clocks free of dust

Medical Equipment and Monitor

Ceilings

Lights

No Visible Spots on Ceilings or Tiles

Horizontal Surfaces

Counters Clean

Bedding - Clean no stains or tears

Bed Rails

Bed Frame

Over the Bed Tables and Pull Outs clean

Bedside NIght Stand - Inside and Outside Surfaces Clean. No Patient Belongings.

TV Remote

Phone Cords clean and Organized

Chairs/Sofa clean including Legs

Garbage cans - Clean, extra bags and Relined

Tables and Legs Clean

Mirrors - No Marks

Windows

Glass Doors

Windows - No Smears

Window Sills

Blinds/Curtains - No Spots

High Dusting

Vents are clean and free of dust on outsides

Over the Bed Light is free of dust

Lift Track and it's Motor free of Dust

Tops of cabinets are free of dust

Floors

No build up in corners of floors

Floors are clean

Baseboards are clean

No dust bunnies behind doors or equipment

Patient Bathroom

Toilet clean on all inside and outside surfaces, under hinges, lid, etc.

No streaking on shelves, paper towel dispensers or any stainless steel surface

Shower clean and free of hair and debris in drain and clean shower curtain

Misc.

Tent Card - Signed, dated and placed on the Over the Bed Table

Sanitary Strip placed over toilet seat

Toilet Paper folded in "V"

Closet and Cabinets empty and clean

Divider Drapes/Curtains free of spots and oil

Employee Signature when Available
Manager Performing Audit

Comments:

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.