Information
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Document No.
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Conducted on
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Prepared by
Room handover checklist
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UNIT
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Room
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Fire door condition
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SPECIFY
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SPECIFY
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Carpet/Vinyl Condition
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SPECIFY
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Chest of drawers
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SPECIFY
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SPECIFY
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Wardrobe
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SPECIFY
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Condition of bed
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Condition of matress
- Good
- Fair
- Poor
- Damaged by resident
- Missing
- Too long - fire hazard
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Condition of bedside cabinet
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SPECIFY
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SPECIFY
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Lights
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SPECIFY
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Heaters
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SPECIFY
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Condition of Walls
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SPECIFY
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SPECIFY
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Condition of Ceilings
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SPECIFY
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SPECIFY
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Condition of smoke detector
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SPECIFY
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Condition of Windows
- GOOD
- DIRTY
- NEEDS REPAIRS
- DAMAGED BY RESIDENT
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SPECIFY
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Specify
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SPECIFY
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Condition of Blinds / curtains
- Good
- Fair
- Poor
- Damaged by resident
- Missing
- Too long - fire hazard
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Specify
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Rectify
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Management informed?
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MANAGEMENT INFORMED?
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Condition of bathroom door
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SPECIFY
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SPECIFY
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Condition of Sink
- GOOD
- DIRTY
- NEEDS REPAIRS
- DAMAGED BY RESIDENT
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Specify
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SPECIFY
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Condition of Toilet
- GOOD
- DIRTY
- NEEDS REPAIRS
- DAMAGED BY RESIDENT
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Specify
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SPECIFY
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Condition of toiletry cabinet
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Room cleaning
- Good
- Fair
- Poor
- Damaged by resident
- Missing
- Too long - fire hazard
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STAFF Signature
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Maintenance Tech Signture
Resident Signature
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I AM AWARE OF ITEMS ABOVE
