EVS Cleaning Audit Checklist Date and / or Time of Use Public Area / Use Patient Date or Day of Time of Day Day to Measure Public Restroom Room Person Week to do to do Outcome Observation Observation Assigned to do Surface Surface Locations in Facility Sheet Sheet the Audit Markings Markings (use blacklight) Patient Room X Chapel X Dining Room X Lobby X Medication Room X Nurse Station X Public Restroom X Solarium X
EVS Cleaning Audit Checklist Locations in Facility Use Public Area / Public Restroom Observation Sheet Use Patient Room Observation Sheet Person Assigned to do the Audit Date or Day of Week to do Surface Markings Time of Day to do Surface Markings Date and / or Time of Day to Measure Outcome (use blacklight) Patient Room X Chapel X Dining Room X Lobby X Medication Room X Nurse Station X Public Restroom X Solarium X
EVS-Cleaning-Audit-Assignment-Worksheet-Acute-Care.docx