Title Page
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Room #
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Conducted on
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Prepared by Guven Parlak
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Floor Supervisor
Housekeeping Room Checklist
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Instructions:
1. Answer "PASS", "FAIL", "N/A" on the questions below.
2. Add photos and notes by clicking on the paperclip icon.
3. To add a Corrective Measure, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
4. Complete audit by providing digital signature.
5. Share your report by exporting as PDF, Word, Excel or Web Link.
DOOR -WALLS -CEILING
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Door - Glass in Door
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Door Frame
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Glass In Door
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Walls
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Stall Partitions
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Wall Bumpers - Hand Rails
WENTS /REGISTERS / HOODS
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Exterior Vents
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Exhaust Hoods
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Speakers
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Registers
FLOORING / CARPET /MAT /BASEBOARDS /CORNER EDGES
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Floor
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Carpet
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Mat
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Baseboards
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Corner and Edges
INTERIOR / EXTERIOR GLASS / WINDOW / MIRROR / CUBICLE CURTAIN
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Windows
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Mirrors
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Screens
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Frames / Sills
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Window Covering
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Cubicle Curtain
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Curtain Tracks
BEDS / STRETCHER / EXAM TABLES
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Beds
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Mattress
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Stretchers Surface
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Examination Table
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Cribs
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Under Carriage
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Base Wheels
FURNITURE / FIXTURES
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Computer Monitor
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Telephone
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Table / Desk
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Pictures / Sign
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Chair - Seating -Couches
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Shelving Cabinet
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Locker / Cabinet
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Signage
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Clock
LIGHTS
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Ceiling / Wall mounted / Free Standing / Over bed
PATIENT EQUIPMENT
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Over Bed side Table
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Call Bell Cords
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Sharp Containers
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IV pole attached to bed
Waste Bins
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Domestic waste Bin
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Bio-hazard Waste Bin
SINK - NON WASHROOM
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Interior Sink - Drain
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Exterior Sink -Underneath piping
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Faucet - Taps
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Dispenser - Hand Sanitizer
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Dispenser - Hand Towel
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Eye Wash Station
TOILET - SHOWER AREA
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Interior Sink - Drain
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Exterior Sink -Underneath piping
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Faucet - Taps
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Dispenser Hand -Towel
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Toilet exterior - seat-knob
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Urinal -bidet
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Shower
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Mirror
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Shower curtains
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Floor Tile
GROOMING STANDARDS
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Uniform
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PPE
Signature
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Inspected by HMGH Staff
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Inspected by Qafam Staff
