Coffee Station; solarium; hallway

Coffee station

Coffee area stocked; cup dispenser filled

Sink cleaned and polished

Counters wiped, machine dusted

Trash emptied, can cleaned

Floors need:

Solarium

Floors clean

Chairs dusted/wiped/vacuumed

Glass and blinds clean

Vending machines dusted

Floors need:

Linen room

Linen covered properly

Floors clean, free of dust bunnies

No linen, pillows, etc on top of carts without being bagged

Floors need:

Med room

Trash cans emptied and cleaned

Floors cleaned and mopped

Floors need:

Soiled utility

No trash or linen on floor

Trash and linen segregated

Floors clean and mopped

Floors need:

Hallway

Hall dust free, floors clean

Free of dust bunnies behind doorways

Baseboards are clean

Floors need:

Room 320

Room 320

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 321

Room 321

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 322

Room 322

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 323

Room 323

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 324

Room 324

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 325

Room 325

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 326

Room 326

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Room 327

Room 327

Floor dust/dirt free corners/edges

Floor under furniture dust/dirt free

Walls dust/dirt free including corners

Window ledges dust/dirt free

Overbed light dust/dirt free

Closets are dust/dirt free

Call light control dust/dirt free

Patient bed rails cleaned

TV set dust/dirt free

Bedside cabinet clean

Over bed table clean

Cubicle curtain clean

Air vents clean

Waste containers clean

Room is odor free

Restroom floor corners/edges clean

Restroom walls dust/dirt free

Toilet cleaned including around and on the bottom

Sink cleaned including bottom

Paper towel dispenser supplied

Soap dispenser supplied

Toilet paper dispenser filled

Hand Sanitizer is in working order and filled

Sharp Container is less than 3/4 full and clean

Floors need:

Work orders needed:

Engineering

Engineering issues

Lighting is in good condition

Light Pull Chord in working condition

Plumbing in working condition

Ceiling tiles and tbar are clean with no stains, cracks, or missing

Paint is in good condition

Doors are in working condition including all hinges

Bathroom door in working order

Shower door in working order

Patient Room door in working order

All outlets in working order

Vents are in working order and are clean of debris and dust

Nurse Call working properly?

TV working properly in correlation to the Nurse Call System?

Are there any holes in the walls?

No Penetrations in the corridors or stairwell

All fire doors latch and close properly

All exit signs are properly working

All stairwell passage lights are working properly?

Are all means of egress free of obstruction both internal and external?

Is flooring in good condition?

Work orders needed:

Approval

Approval of these rounds are accepted by:

EVS Representative:
Clinical Unit Director/CSM
Engineering Representative:
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.