Title Page

  • Site conducted

  • Conducted on

  • Location

Operational Checkpoints

  • Have you check the corridors and stairwells? (filled, working & clean hand sanitizer dispenser/trays, pull trash, clean/dust free floors, dust free vents, pictures, behind fire doors, wet floor signs removed)

  • Have you checked the nurses’ station? (hand soap, hand sanitizer, paper towel, clean sink, trash pull)

  • Have you checked the soiled utility closet? (odor free, no trash/linen/Bio on the floor, clean sink & hopper, no housekeeping supplies, clean floor, soap & paper towels)

  • Have you checked the clean equipment & supply closet? (dust free warmers, Pyxis, floors, covered & stocked linen, clean sink, soap, paper towels, medical & pharmaceutical waste)

  • Have you check the housekeeping closet? (locked jfill, eyewear, no supplies, labeled chemicals)

  • Have you checked the nourishment area? (clean sink, external ice machine/trays, external fridge, microwave, coffee maker, counter tops, floors, sink, soap & paper towels available, empty trash & clean floors)

  • Have you checked the public restrooms & public area? (elevator & tracks, vacuum carpet, vending area, sink, available supplies, toilet, floors & odor free)

  • Have you checked in with the customer, patients & empty rooms (perform QAs on empty rooms, nurse leaders & patients compliance checks with housekeepers, verify terminal cleaning logs-if applicable)

  • Have you check ControlTex & supply pars in housekeeping closet?

  • Have you checked the loading dock & bio area (secured, clean & tidy)

  • Have you checked Scrubex Machine? (Empty soiled & fill)

  • Have you checked the house census? (update EVS flight tracker, connect with Charge Nurses & House Supervisor)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.