EVS Cleaner Skills Checklist
   NAME  
   Email-Id
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:

This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
Rating Stars (Click)
EVS Cleaner Skill Checklist 1
2
3
4
Personal protective equipment (PPE) such as gloves, gowns and goggles/face shield
Clean cloths, solution, and mop
Dirty/used items
Curtains if visibly soiled
Trash container and liner
Sharps container if ¾ or more full
Hand soap, hand sanitizer, shower soap, shampoo
Paper towels
Toilet paper
Facial tissue
Vents
Lights
Framed pictures
TV and wires
Window sills
Door surface and knobs
Bed rails
Tray tables
Bedside tables, including drawers
Telephones
Light Switches
TV remotes
Bed remotes
Call buttons
Outside surfaces of medical equipment (using approved procedure)
Chairs and other furniture
Other horizontal surfaces
Light switches
Door knob
Hand rails
Faucet
Sink
Tub/shower
Mirror
Toilet seat
Flush handle
Bedpan cleaner
Dust mop the room
Wet the mop head in disinfectant, and starting at the side of the room farthest from the bathroom, mop half of the room
Mop the bathroom shower floor and bathroom floor
Flip the mop head and mop the rest of the room
Change out mop heads after isolation rooms