MHEOC

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Patient Rooms

• Any contraband found?

  Yes

  No

  N/A

• Any excess linens or clothing?

  Yes

  No

  N/A

Patient Care Area

• Trash contained to paper bags? Trash bags free of plastic waste?

  Yes

  No

  N/A

• Any unused / unsupervised presence of pens / pencils?

  Yes

  No

  N/A