• Check all that apply and note if followup is needed. Complete this audit for each area weekly or for random audits as needed.

  • Audit Location


  • Floors are clean/vacuumed/free of dust

  • Floor under bed/furniture is clean and free from dust

  • There is no wax buildup in corners or on baseboards

  • There are no stains on the floors?


  • Light fixtures are clean

  • Vents are clear from dust

  • Ceilings are clean and free from cobwebs


  • Walls are clean

  • Windows, window ledges, and screens are clean<br>

  • Window coverings are clean

  • Stainless steel is clean

  • Cubical curtains are clean

  • Doors and handles/knobs are clean


  • Bed rails and under mattress are clean

  • Tray Table

  • Tray Table Handles

  • IV Pole<br><br>

  • IV Pump Controls<br><br>

  • Call Button

  • Telephone

  • Chair/Couch

  • Room Light Switch

  • Room Inner Door Knob

  • Sharps Container and Area

  • Area is free from insects and pests

  • Waste baskets are empty

  • Furniture in room is clean and free of defects


  • Bathroom sink is clean

  • Bathroom handrails

  • Bathroom mirror is clean

  • Bathroom door knob

  • Bathroom light switch

  • Shower is clean

  • Top of dispensers are clean

  • Toilet and plumbing/pipes are clean

  • Floor is clean


  • Supplies are replenished

  • Card is placed


  • Closet is clean and orderly

  • Closet is stocked appropriately


  • Please enter any additional comments about this audit.

  • Date and Time of Audit

  • Please sign your name here to certify this audit as complete

  • Please email this audit to: Rachel White -

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