Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Environment
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1. Overall Appearance
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2. Odour Control
Patient Equipment
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3. Commodes, weighing scales, manual handling equipment
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4. Medical Equipment including intravenous infusion pumps, drip stands and pulse oximeter (not connected to patient)
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5. Medical Equipment including intravenous infusion pumps, drip stands and pulse oximeter (Connected to Patient)
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6. Patient Washbowls
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7. Bedside oxygen and suction connectors, earpiece for bedside entertainment system
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8. Patient Fans
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9. Bedside Alcohol handwash container, clipboards and notice boards
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10. Notes and Drugs trolley
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11. Patient personal items including cards and suitcases
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12. Linen Trolley
BUILDING - External and internal features
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13. Entrance/ Exit
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14. Stairs (Internal and External)
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15. External Areas
BUILDING - Fixed Assets
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16. Switches, sockets and data points
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17. Walls
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18. Ceiling
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19. All doors
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20. All glazing, including partitions
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21. Mirrors
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22. Bedside patient TV
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23. Radiators
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24. Ventilation grilles extracts and inlets
BUILDING - Hard Floors
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25. Floor - polished
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26. Floor - non-slip
BUILDING - Soft Floors
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27. Soft Floor
FIXTURES - Electrical fixtures and appliances
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28. Pest Control Devices
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29. Electrical Items
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30. Cleaning Equipment
FIXTURES - Furnishings, Fixtures and Fittings
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31. Low Surfaces
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32. High Surfaces
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33. Chairs
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34. Beds
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35. Lockers
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36. Tables
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37. All dispensers and holders
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38. Waste recepticles
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39. Curtains and Blinds
FIXTURES - Kitchen Fixtures and appliances
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40. Dishwasher
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41. Fridge and/or Freezer
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42. Ice Machine and/or hot water boiler
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43. Kitchen cupboards
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44. Microwave
FIXTURES - Toilets, sinks, hand-wash basins and bathroom fixtures
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45. Shower
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46. Toilet and Bidet
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47. Replenishment
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48. Sinks
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49. Bath
