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| Original Work Location |
{loc_name} |
| Temporary Work Location |
{ReportLabel1} |
| Document Date |
{doc_date} |
| Coordinator |
{coordinator} |
| Staff Name |
{staff_name} |
| Is the counter free of all dust, dirt and food particles? Are items on the counter organized and neat in appearance? |
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| Is the floor free of all dust, dirt and food particles? Are all walkways clear? Are all floor areas free of unncessary items? |
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| Is the stove top free of all items and wiped down? |
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| Is the microwave free of splatters, food particles etc? |
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| Are all items in the refrigerator properly stored? Are all expired items removed from the refrigerator? Have all spills been wiped up? |
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| Are all items in the freezer properly stored? Have all spills been wiped up? |
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| Are all items in the cabinets stored properly? Are shelves neat in appearance? |
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| Notes |
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| Is all furniture arranged properly? Have couches been vacuumed and tables dusted? |
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| Is the floor free of all dust, dirt and food particles? Are all walways clear? Are all floor areas free of unnecessary items? Have carpets been vacuumed and/or steam cleaned? |
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| Have all windows been wiped? Are blinds and properly closed? |
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| Are all cabinets and wires properly stored? Are all items in good working condition? |
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| Are all walls free of marks, holes etc? Are all pictures hung straight? |
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| Notes |
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| Do all individuals have appropriate bedding? Are all beds assembled properly and look orderly? |
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| Have all floors been washed or vacuumed? Do any need steam cleaning? |
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| Are all items stored in dressers folded and organized? Are all dresser drawers closed? Do individuals have adequate space to store their belongings? |
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| Do all bedrooms have proper lighting? |
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| Are all walls free of marks, holes etc? Are all pictures hung straight? |
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| Notes |
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| Are items on the vanity arranged neatly? Have the sinks been wiped down? |
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| Are all floors dry and free of debris? Are all mats cleaned and orderly? |
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| Has the toilet been cleaned? Is it in good working order? |
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| Are the walls and basin mildew free? Are items in the shower organized neatly and appropriately? |
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| Are all walls free of marks, holes etc? Are all pictures hung straight? |
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| Notes |
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| No records |
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