CA 7- 30 Day Deep Room Cleaning

To be completed by EVS. Room vacated for cleaning purposes, minimally done every 30 days (regardless of number of admissions or patient occupancy) with hospital approved disinfectant.

Which department are you completing this survey for?

Name of the employee observed:

Routine discharge cleaning performed
Sanitize floors, baseboards and corners
Sanitize all surfaces below shoulder level (including walls)
Replace/sanitize/launder privacy curtains per hospital policy
Replace glove boxes
Wipe down sharps, soap and hand sanitizer containers (outside), glove and gown box holders
Windows cleaned
Furniture such as couches, recliners, etc. cleaned
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