Resident Room Discharge Inspection
Housekeeper Initials
Date
-
Month
-
Day
Year
Date
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Inspected By
Peggy
Shannon
Trinie
Paul
Debbie
"Other" - Please note below
**Re-Clean Inspection**
"Other" Inspector
Room Number
'Room Readiness' sheet in box behind door and filled out?
Yes
No
Restroom - Toilet and base of toilet clean? Sink & pipes clean?
Yes
No
Shared with other resident - N/A
Comment
High & low dusting - all horizontal surfaces dust free - window sills, heater, furniture, lights
Yes
No
Comment
Bed - head board, foot board, mattress, frame
Yes
No
Comment
Furniture - chair, dresser, night stand, lamp, drawers
Yes
No
Comment
Walls clean, no splatter or spots
Yes
No
Comment
Blinds / Shade, window glass clean & spot free?
Yes
No
Comment
Floors Clean and free of debris - under and behind furniture
Yes
No
Comment
Touch points - light switches, remotes, bed controls, faucet, toilet handle
Yes
No
Comment
All misc equipment moved to storage?
Yes
No
What equipment was left in room?
Misc Comments, Plant Ops Concerns
Score %
Pictures
Browse Files
Cancel
of
Submit
Should be Empty: