Laundry Checklist BLANK
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7/27/2019 Laundry Checklist BLANK http://slidepdf.com/reader/full/laundry-checklist-blank 1/2 LAUNDRY SERVICES ESTABLISHMENT INSPECTION REPORT Establishment: Location: Date of Inspection: Item No. ITEM DESCRIPTION S U Item No. ITEM DESCRIPTION S U 01 TRANSPORT AND DELIVERY Delivery vehicles protected, clean, sanitized. Capacity of vehicles adequate. 19 Master Cleaning and Terminal Cleaning Schedules developed, implemented and documented 02 Linen properly wrapped, stored, handled – clean and soiled laundry transported separately. 20 Permanent Maintenance Crew available. Preventive Maintenance Schedule implemented. Maintenance activities documented. 03 Supply of clean linen is adequate to meet needs of facility. 21 FACILITIES AND EQUIPMENT Soiled and clean linen areas adequately separated, (separate doors) clean, uncluttered, free of trash. 04 LAUNDRY OPERATIONS Proper chemical used; Detergent, Bleach, Sour/Wash formula approved/time and temperatures adequate. Wash temp…Rinse temp…. Wash time….Rinse time…. 22 Equipment properly installed, maintained in good repair, clean. 05 T emp er atu re gau ge s – Ti me rs Automatic Programming provided adequate/maintained 23 Soiled and clean laundry cans/tables properly identified and used. Easily cleanable, properly cleaned and disinfected 06 Contaminated and heavily soiled items given appropriate treatment: - surgical and contaminated at 71°C (160°F) for a minimum of 20 minutes - heavily soiled washed separate - contaminated not sorted 24 Ventilation adequate, proper flow and direction. 07 Water source safe, hot and cold under pressure. Cold water disinfected. At least 0.5 PPM available chlorine. 25 Lighting provided as required: 70 foot candles 76 cm (30 inches) from floor – lights shielded. 08 Sufficient boiler capacity to maintain hot wash cycle requirements. 26 Sewage and solid waste properly disposed of/No nuisance conditions existing. 09 Clean and soiled linen completely separate throughout processing. 27 Plumbing properly installed & maintained, no cross connections, backflow or back-siphonage. 10 Personnel free of communicable disease – valid medical examination/personnel with infections restricted. 28 Building insect and rodent proof, no presence of insects and rodents. Pesticides – Methods of application/frequency. 11 Hands washed properly – kept clean. 29 Toilet and hand-washing facilities accessible, convenient, properly designed, installed, maintained and supplied with hand cleanser, sanitary hand drying devices, tissue, waste receptacles. 12 Clean, light colored uniforms, protective garments provided and worn as needed. 30 Floors properly constructed, easily cleanable, drained, maintained clean. 13 Key personnel –Manager, Operations Super- visor; Foreman – Quality insurance Qualifications/ experience. 31 Walls, ceilings, attached equipment properly constructed, easily cleanable, light colored. 14 Adequate hygiene guidelines – in-service training provided, documented, understood 32 Storage racks in properly constructed, good repair, clean/repaired laundry re-laundered. 15 No eating, drinking, smoking in laundry processing area/visitors restricted 16 QUALITY IMPROVEMENT Policies and Procedures developed and implemented with regard to Healthcare Facility linen process. 33 EMPLOYEE HOUSING Employee housing accommodation clean, sanitary, well maintained. 17 Documentation of Operational Problems and Solutions. 18 In -Ho use re vie w o f l au nd ry Operation/Program.
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Transcript of Laundry Checklist BLANK
7/27/2019 Laundry Checklist BLANK
http://slidepdf.com/reader/full/laundry-checklist-blank 1/2
LAUNDRY SERVICES ESTABLISHMENT INSPECTION REPORT
Establishment: Location: Date of Inspection:
Item
No.
ITEM DESCRIPTION S U Item
No.
ITEM DESCRIPTION
S U
01
TRANSPORT AND DELIVERY
Delivery vehicles protected, clean,sanitized. Capacity of vehicles adequate.
19 Master Cleaning and Terminal Cleaning
Schedules developed, implemented anddocumented
02 Linen properly wrapped, stored, handled –clean and soiled laundry transportedseparately.
20 Permanent Maintenance Crew available.Preventive Maintenance Schedule implemented.Maintenance activities documented.
03 Supply of clean linen is adequate to meetneeds of facility. 21
FACILITIES AND EQUIPMENTSoiled and clean linen areas adequatelyseparated, (separate doors) clean, uncluttered,free of trash.
04LAUNDRY OPERATIONSProper chemical used; Detergent, Bleach,Sour/Wash formula approved/time andtemperatures adequate.Wash temp…Rinse temp….Wash time….Rinse time….
22 Equipment properly installed, maintained in goodrepair, clean.
05 Temperature gauges – Timers
Automatic Programming providedadequate/maintained
23 Soiled and clean laundry cans/tables properly
identified and used. Easily cleanable, properlycleaned and disinfected
06 Contaminated and heavily soiled itemsgiven appropriate treatment:- surgical and contaminated at
71°C (160°F) for a minimum of 20
minutes- heavily soiled washed separate- contaminated not sorted
24 Ventilation adequate, proper flow and direction.
07 Water source safe, hot and cold under pressure.Cold water disinfected. At least 0.5 PPMavailable chlorine.
25 Lighting provided as required: 70 foot candles 76cm (30 inches) from floor – lights shielded.
08 Sufficient boiler capacity to maintain hotwash cycle requirements.
26 Sewage and solid waste properly disposed of/Nonuisance conditions existing.
09 Clean and soiled linen completelyseparate throughout processing.
27 Plumbing properly installed & maintained, nocross connections, backflow or back-siphonage.
10 Personnel free of communicable disease – valid medical examination/personnelwith infections restricted.
28 Building insect and rodent proof, no presence of insects and rodents. Pesticides – Methods of application/frequency.
11 Hands washed properly – kept clean. 29 Toilet and hand-washing facilities accessible,convenient, properly designed, installed,maintained and supplied with hand cleanser,sanitary hand drying devices, tissue, wastereceptacles.
12 Clean, light colored uniforms, protectivegarments provided and worn as needed.
30 Floors properly constructed, easily cleanable,drained, maintained clean.
13 Key personnel –Manager, OperationsSuper-visor; Foreman – Quality insuranceQualifications/ experience.
31 Walls, ceilings, attached equipment properlyconstructed, easily cleanable, light colored.
14 Adequate hygiene guidelines – in-servicetraining provided, documented,
understood
32 Storage racks in properly constructed, goodrepair, clean/repaired laundry re-laundered.
15 No eating, drinking, smoking in laundryprocessing area/visitors restricted
16QUALITY IMPROVEMENTPolicies and Procedures developed andimplemented with regard to HealthcareFacility linen process.
33 EMPLOYEE HOUSINGEmployee housing accommodation clean,sanitary, well maintained.
17 Documentation of Operational Problemsand Solutions.
18 In-House review of laundryOperation/Program.
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REMARKS
Inspection made by Accompanied by : Date Time
