ROSEVILLE EVS CLEANING CART INSPECTION OBSERVATION

• NAME

• Date / Time

  Date

• Prepared by

• Floor / Room
  Address

• Personnel

CART OBSERVATION

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

NAME. &. DATE

• Debra. <br>Cart location

  Yes

  No

  N/A

Cart Observation

• Dusting Tools Present

  Yes

  No

  N/A

• Wet mop handle and head present and in good condition?

  Yes

  No

  N/A

• Cart is organized according to Cart Set Up Card?

  Yes

  No

  N/A

• Cart is clean and presentable to the customers and Caddy is clean?

  Yes

  No

  N/A

• All products and buckets are label properly with secondary labels?

  Yes

  No

  N/A

• Wet floor signs/wet floor magnets are on cart"

  Yes

  No

  N/A

• No personal items, food, or drink and/or personal stickers are present?

  Yes

  No

  N/A

• All buckets are present, clean, and utilized properly ?

  Yes

  No

  N/A

• Dust pan and lobby broom is present and clean and emptied?

  Yes

  No

  N/A

• Putty knife, small grout brush, white scrub pad present?

  Yes

  No

  N/A

Cleaning Products

• DFC cleaner/germicidal cleaner

  Yes

  No

  N/A

• Pure Brite disinfectant bleach wipes

  Yes

  No

  N/A

• Liquid abrasive cleaner

  Yes

  No

  N/A

• Stainless steel cleaner

  Yes

  No

  N/A

• Gum off

  Yes

  No

  N/A

Supplies Stocked

• Hand washing soap

  Yes

  No

  N/A

• Toilet paper

  Yes

  No

  N/A

• Plastic liners appropriate to area

  Yes

  No

  N/A

• Microfiber mops (appropriate amount not over stock)

  Yes

  No

  N/A

• High touch laminated cars present and other instruction cards

  Yes

  No

  N/A

• Seat covers

  Yes

  No

  N/A

• Paper towels

  Yes

  No

  N/A

• Microfiber towels (Appropriate amount not over stock)

  Yes

  No

  N/A

• EVS service cards/tent cards <br>(Hospital only)

  Yes

  No

  N/A