Title Page

  • Room Name

  • Geisinger Building Name

  • Conducted on

  • Personnel

  • Prepared by: ASM Environmental, LLC

Geisinger Parameters

  • If you are unable to get in the room via your badge or key, please call DC Operations at 271.6818

  • Does key work?

  • What type of key is it? (via engraved letters on the key)

  • If key works, please close door and use prox card for entry

  • Does the prox card reader work?

  • Is there a camera?

  • Picture of camera

  • Room Assessment

  • Picture(s) of Room From Doorway (Before)

  • Is there a room doorway barcode identifier?

  • Picture of Room Doorway Barcode Identifier

  • Is placard on outside of room with room name?

  • Picture of Placard

  • Is equipment piled to one area?

  • General Comments:

ASM Environmental Cleaning Parameters

  • Dust off tops of racks

  • Vacuum inside racks/cabinets if needed (be cautious around cables)

  • HEPA vacuum floor and walls (ceiling if needed or applicable; be cautious around smoke detector)

  • Damp mop flooring

  • Remove cardboard/bottles/wire clippings/general trash

  • Any manuals or loose equipment should be consolidated to one spot (if possible)

  • After cleaning the room picture(s).

  • Add signature

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