Room Cleaning

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Created by Qualaris Staff

Environmental Services

Use this tool to organize how you audit and track compliance with room cleaning. Customize the form to support the monitoring method(s) and specific areas and equipment within the room that will be audited. Some hospitals use the feature “Share this submission by Email” to forward issues directly to an EVS/housekeeping supervisor when they’re encountered during audits.

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Audit Form

Room Cleaning

Required

Observed Date

Unit

Shift

Monitoring Method

Bed rails/controls

Tray table

IV pole

Call box/button

Telephone

Bedside table handle

Chair

Room sink

Room light switch

Room inner door knob

Bathroom inner door knob/plate

Bathroom light switch

Bathroom handrails by toilet

Bathroom sink

Toilet seat

Toilet flush handle

Toilet bedpan cleaner

IV pump control

Monitor controls

Monitor touch screen

Monitor cables

Ventilator control panel

Room Cleaning

Table of Contents

Audit Form

Room Cleaning

Room Cleaning Checklist