SMS INTEGRATED FACILITY SERVICES PVT LTD.
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Patient Round Checklist- LEVEL 2
Shift:- Date:-
Room & Tissue & Good Patient /
Toilet Linen Patient / Supervisor
Sr.No. Room No All Hand Water Jar night Any Complaint Relative
Clean Change Relative Sign Sign
Cleaning Wash machine Name
1 201
2 202
3 203
4 204
5 205
6 206
7 207
8 208
9 209
10 210
11 211
12 212
13 213
14 214
15 215
16 216
17 217 (A)
18 217 (B)
19 218
20 219
21 220
22 221
23 222
24 223
Electrical Kettle Available Good Night Machine Supervisor Sign Executive Sign
25 205 216 217 Level 1 Stock
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Houskeeping Cleaning Checksheet
Shift:- Staff Name- Date:-
Garbage Garbage High Level Ward Incharge
Time Area Dry Mop Wet Mop Dusting Toilet Cleaning HK Staff Sign Sup Sign
Removing Cleaning Dusting sign
MICU
ER
Minor OT
Doctor Room
107-08
8 to 11
109-10
111-12
Genral Ward
DU/CU
Passage
MICU
ER
Minor OT
Doctor Room
107-08
11 to 02
109-10
111-12
Genral Ward
DU/CU
Passage
MICU
ER
Minor OT
Doctor Room
107-08
02:30 to 4:30
109-10
111-12
Genral Ward
DU/CU
Passage
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
SMS INTEGRATED FACILITY SER
Daily Houskeeping Clea
Shift:-
Time Area Frequency Dry Mop Wet Mop
113/114
115/116
117/118
119
120
Morning
121
Genearl ward
NS cabimn
Passage
DU/CU
113/114
115/116
117/118
119
120
Evening
121
Genearl ward
NS cabimn
Passage
DU/CU
113/114
115/116
117/118
119
120
Night
121
Genearl ward
NS cabimn
Passage
DU/CU
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
TEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Houskeeping Cleaning Checksheet
Staff Name- Date:-
Garbage Dustbin High Level
Dusting Toilet Cleaning HK Staff Sign
Removing Cleaning Dusting
Client Sign:-
Date:-
Ward Incharge
Sup Sign
sign
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Houskeeping Cleaning Checksheet ( Special Checklist for Recovery HDU/PICU)
Shift:- Staff Name- Date:-
Suction Ward
Garbage Dirty Room High Level HK Staff
Time Area Frequency DRY Mop Wet Mop Dusting Bottle Sup Sign Incharge
Removing Cleaning Dusting Sign
Cleaning Sign
Recovery Twice in a shift
HDU Twice in a shift
BIO Medical Dept. Twice in a shift
Morning
PICU Left Side Twice in a shift
Milk Bank Twice in a shift
PICU Right Side Twice in a shift
Recovery Twice in a shift
HDU Twice in a shift
BIO Medical Dept. Twice in a shift
Evening
PICU Left Side Twice in a shift
Milk Bank Twice in a shift
PICU Right Side Twice in a shift
Recovery Twice in a shift
HDU Twice in a shift
BIO Medical Dept. Twice in a shift
Night
PICU Left Side Twice in a shift
Milk Bank Twice in a shift
PICU Right Side Twice in a shift
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Houskeeping Room Cleaning Checksheet - LEVEL 2
Shift:- Staff Name-
Garbage
Time Area Frequency DRY Mop Wet Mop Dusting
Removing
201 Twice in a shift
202 Twice in a shift
203-204 Twice in a shift
205 Twice in a shift
Morning 206 Twice in a shift
207 Twice in a shift
208-209 Twice in a shift
210-211 Twice in a shift
212-213 Twice in a shift
201 Twice in a shift
202 Twice in a shift
203-204 Twice in a shift
205 Twice in a shift
Evening 206 Twice in a shift
207 Twice in a shift
208-209 Twice in a shift
210-211 Twice in a shift
212-213 Twice in a shift
201 Twice in a shift
202 Twice in a shift
203-204 Twice in a shift
205 Twice in a shift
Night 206 Twice in a shift
207 Twice in a shift
208-209 Twice in a shift
210-211 Twice in a shift
212-213 Twice in a shift
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Daily Houskeeping Room Cleaning Checksheet - LEVEL 2
Shift:- Staff Name-
Garbage
Time Area Frequency DRY Mop Wet Mop Dusting
Removing
214-215 Twice in a shift
216 Twice in a shift
217-217 B Twice in a shift
218 Twice in a shift
219 Twice in a shift
Morning
220 Twice in a shift
221 Twice in a shift
222 Twice in a shift
223 Twice in a shift
DU Room Twice in a shift
214-215 Twice in a shift
216 Twice in a shift
217-217 B Twice in a shift
218 Twice in a shift
219 Twice in a shift
Evening
220 Twice in a shift
221 Twice in a shift
222 Twice in a shift
223 Twice in a shift
DU Room Twice in a shift
214-215 Twice in a shift
216 Twice in a shift
217-217 B Twice in a shift
218 Twice in a shift
219 Twice in a shift
Night
220 Twice in a shift
221 Twice in a shift
222 Twice in a shift
223 Twice in a shift
DU Room Twice in a shift
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
ICES PRIVATE LIMITED
g Checksheet - LEVEL 2
Staff Name- Date:-
Ward
Toilet Dustbin High Level HK Staff
Sup Sign Incharge
Cleaning Cleaning Dusting Sign
Sign
Client Sign:-
ICES PRIVATE LIMITED
g Checksheet - LEVEL 2
Staff Name- Date:-
Ward
Toilet Dustbin High Level HK Staff
Sup Sign Incharge
Cleaning Cleaning Dusting Sign
Sign
Client Sign:-
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Water Cooler Cleaning Checklist
Area:- Date:-
Sr.NO Cleaned On Date Next Due Date Cleaned By Supervisor Sign Floor Incharge Sign
10
11
12
Remarks:-
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
SMS INTEGRATED FACILITY SERVICES PRIVATE LIMITED
Ward Daily Cleaning Checklist- NICU
Work Scope
M E N M E N M E N M E N M E N M E N M E N
Scope
Suction Bottle
Oxygen Bottle Cleaning
Patient Locker & Bed Cleaning
Food Table Cleaning
Oxygen Panel Cleaning
IV Stand Cleaning
Urine Pot Cleaning
Bed Pan Cleaning
BMW Dustbin Cleaning
Wheel Chair Cleaning
Strecher Cleaning
Nursing Counter Cleaning
Storage Rack Cleaning
ECG Machine Cleaning
Crash Cart Trolly Cleaning
Attendant Bed Dusting
Wall, Window, Door Cleaning
PCA Staff Sign
Hk Sup Sign
Ward Inchgarge Sign
ICN sign
HK Supervisor Sign:- Ops Executive Sign:- Client Sign:-
