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

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?

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?