Roseville evs cleaning cart inspection observation. template checklist
**********evaluation findings: mark y or n and circle item not meeting standards**********
What does this form include?
This form contains 4 sections:
CART OBSERVATIONS
- 1. Dusting tool present
- 2. Wet mop handle and head is present and in good condition?
- 3. CRT is organized according to cart set up card?
- 4. cart is clean and presentable to the customers and caddy is clean?
- 5. All products and buckets are labels properly with secondary labels?
- 6. Wet floor sign/wet floor magnets (6) Re on cart?
- 7. No personal items, Food or drinks and/or personal stickers are present?
- 9. Dust pan and lobby broom is present and clean and emptied?
- 10. Putty knife, small grout brush, white scrub pad present?
CLEANING PRODUCTS
- 11. DFC Cleaner / Germicidal cleaner
- 12. Pure Brite disinfectant/Bleach wipes
- 13. Liquid abrasive cleaner
- 14. Stainless Steel cleaner
- 15. Gum off
- 16.
SUPPLIES STOCKED. EQUIPMENT/OTHER OBSERVATION
- 17. Hand washing soap. (4)
- 18. Toilet paper (4)
- 19. Plastic liners appropriate to area
- 20. Microfiber mops (appropriate amount not over stocked)
- 21. High touch laminated card present and other instruction cards?
- 22. Seat covers (4)
- 23. Paper Towels (2 - 4)
- 24. Microfiber Towels (appropriate amount and not overstocked)
- A25. EVS Service Cards / Tent cards (Hospital only)
FOLLOW UP ACTION
- Individual teaching provided to employee. DATE
- In service needed for the department DATE
- EVS COMMUNICATION MEMO. DATE
- Share at up coming Huddle. DATE
- Review or revise policy and procedures. DATE
- Add to EVS UBT agenda. DATE
- Other comments.
Use this template