James Rose

Patient Room - Environmental Quality Evaluation - (E.Q.E.) Revised* Checklist

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Audit

PATIENT ROOM:

PT. Room #

1. Overbed Table Cleaned?

2. Night Stand Cleaned?

3. Phone Cleaned?

4. T.V Cleaned free of Dust?

5. Picture Frame Clean & free of Dust?

6. Overbed Light Cleaned free of Dust? (Discharge Only)

7. Closet Cleaned?

8. Walls Cleaned?

9. Vents Cleaned free of dust?

10. Ceiling Cleaned?

11. Door Cleaned?

12. Door Handle Cleaned?

13. Door Frame Cleaned?

14. Waste Can Cleaned?

15. Is Floors being mopped according to standard cleaning procedure?

a. Is appearance of the floors meet satisfactory condition?

16. Cubicle Curtain Cleaned & Fully Functional?

17. Room/Furniture Organized?

PATIENT RESTROOM:

1. Toilet Bowl Cleaned?

2. Sink Cleaned?

3. Shower Cleaned?

4. Shower Curtain Cleaned & Fully Functional?

5. Supply dispensers cleaned?

6. Is Floors being mopped according to standard cleaning procedure?

Signature By:

James Rose

Patient Room - Environmental Quality Evaluation - (E.Q.E.) Revised*

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.