Facility check- Patient room (IPD) - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

MAIN DOOR

• Clean and dust free

  Yes

  No

  N/A

• Functioning properly (opening and closing)

  Yes

  No

  N/A

• Not chipped or cracked

  Yes

  No

  N/A

• Is the fire evacuation clear and visible

  Yes

  No

  N/A

Cupboard

• Clean and dust free

  Yes

  No

  N/A

• Two hangers and one pair of sleepers available

  Yes

  No

  N/A

• Functioning properly (opening and closing)

  Yes

  No

  N/A

• Not chipped or cracked

  Yes

  No

  N/A

Patient bed

• Clean and dust free

  Yes

  No

  N/A

• Bed is functionally properly to control

  Yes

  No

  N/A

• Nurse call bell working

  Yes

  No

  N/A

• Hand rub is awailable at bed side

  Yes

  No

  N/A

• Clean linen was provided

  Yes

  No

  N/A

Attendant couch

• Clean and dust free

  Yes

  No

  N/A

• Upholstery intact

  Yes

  No

  N/A

Blinds

• Clean and dust free

  Yes

  No

  N/A

• Working & fixed properly

  Yes

  No

  N/A

Floor

• Clean and dust free

  Yes

  No

  N/A

• Pasted properly

  Yes

  No

  N/A

Window glass

• Clean and smudge free

  Yes

  No

  N/A

• Window not cracked

  Yes

  No

  N/A

• Frames fixed properly

  Yes

  No

  N/A

• Properly filmed

  Yes

  No

  N/A

Walls and ceiling

• Clean and stain free

  Yes

  No

  N/A

• No cracks on wall and ceilling

  Yes

  No

  N/A

• Painted well

  Yes

  No

  N/A

• Is the smoke detector working appropriately

  Yes

  No

  N/A

• Is Fire sprinkler is without obstructions

  Yes

  No

  N/A

AC

• Outlet Grill Clean and dust free

  Yes

  No

  N/A

• Thermostat working properly

  Yes

  No

  N/A

Television

• TV remote is working

  Yes

  No

  N/A

• TV signals are clear

  Yes

  No

  N/A

Toilet

• Mirror is stain less

  Yes

  No

  N/A

• Shower curtain is clean

  Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A