Environment of Care Compliance

Which department are you completing this survey for?

Supply bins are free of visible dust, spills, and debris.

Please comment on findings.

Medication room is free of expired supplies.

What supply was expired?

Medication room is free of extra supplies stored on counters/floors.

Please comment on findings.

Medication room is free of outside shipping cardboard boxes.

Clean, interior cardboard is acceptable.

Please comment on findings.

Appropriate PPE available (minimally, gloves are stocked).

Please comment on findings.

What is the medication room number?