Room Readiness Checklist

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PATIENT ROOM READINESS CHECKLIST

Room No : Time :
SL No
Item Available Functional Repair Required

Patient Cot/Mattress/side
1
railings

2 Attendant Cot / Mattress

3 Call Bell

4 Cardiac Table / IV Stand

5 Hot Kettle / Glasses

6 Linen / Patient Dress

7 Landline / Numbers

8 Refrigerator / Fan

9 Television / Remote

10 Dustbin

11 Bath Towel / Handtowels

Washroom

12 Wc / Dust bins

13 Washbasin & Fittings

14 Bucket & Mug

15 Geyser

16 Soap Dispenser

17 Toilet Kit

General

18 Window Glass/Groves

19 Sidewalls

20 Curtain/Blind
21 Chair/Sofa

Wall Seepage/Water
22
Leakage

23 Electricity Points/Lights

24 Ceiling/Tiles

25 Door/Knobs/ Stopper

Housekeeping Supervisor :

Nursing incharge / PCC :


ESS CHECKLIST

Supervisors Name :

Cleaned Not Cleaned Remarks


Signature

Signature
PATIENT ROOM READINESS CHECKLIST

Room No : Time :
SL No
Item Available Functional Repair Required

Patient Cot/Mattress/side
1
railings

2 Attendant Cot / Mattress

3 Call Bell

4 Cardiac Table / IV Stand

5 Hot Kettle / Glasses

6 Linen / Patient Dress

7 Fan

8 Dustbin

9 Bath Towel / Handtowels

Washroom

10 Wc / Dust bins

11 Washbasin & Fittings

12 Bucket & Mug

13 Geyser

14 Soap Dispenser

15 Toilet Kit

General

16 Window Glass/Groves

17 Sidewalls

18 Curtain/Blind

Wall Seepage/Water
19
Leakage

20 Electricity Points/Lights
21 Ceiling/Tiles

22 Door/Knobs/ Stopper

Housekeeping Supervisor :

Nursing incharge / PCC :


SS CHECKLIST

Supervisors Name :

Cleaned Not Cleaned Remarks


Signature

Signature
PATIENT ROOM READINESS CHECKLIST

Room / Bed No : Time :


SL No
Item Available Functional Repair Required

Patient Cot/Mattress/side
1
railings

2 Attendant Chair

3 Call Bell

4 Cardiac Table / IV Stand

5 Water Jug & Glasses

6 Linen / Patient Dress

7 Fan

8 Dustbin

9 Bath Towel / Handtowels

Washroom

10 Wc / Dust bins

11 Washbasin & Fittings

12 Bucket & Mug

13 Geyser

14 Soap Dispenser

15 Toilet Kit

General

16 Window Glass/Groves

17 Sidewalls

18 Curtain/Blind

19 Wall Seepage/Water Leakage

20 Electricity Points/Lights
21 Ceiling/Tiles

22 Door/Knobs/ Stopper

Housekeeping Supervisor :

Nursing incharge / PCC :


SS CHECKLIST

Supervisors Name :

Cleaned Not Cleaned Remarks

s
Signature

Signature

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