Attachment_2_HOTEL_EVALUATION_CHECKLIST.pdf

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Attached to
Lodging for the Patients at the National Institutes of Health Clinical Center
Solicitation number
HHSN16-R-001621
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Attachment 2 Hotel Evaluation Checklist

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ATTACHMENT: #1

YES NO NA

YES NO NA

DATE NAME (PLEASE PRINT) SIGNATURE

EVALUATORS

Spare toilet tissue/facial tissue

One wrapped drinking glass per person

Bathroom waste basket

One individually wrapped bar of soap per person

One quality bath/hand/wash towel/bath mat

Towel rack

OTHER BATH REQUIREMENTS

BATH TOWELS

Non-skid pad/strips

VANITY/SINK

Functioning/clean

Adequate water pressure/hot water

Clean pillow(s)/pillow cases

Two clean sheets, mattress pad

Clean pillow case(s)

Suitable, clean blanket, bedsheet

Private bath (with no carpeting in commode area

Adequate ventilation (fan/window)

Adequate lighting

BATH AREA

TOILET

Non-sagging/ sized to fit bed frame

Ordorless, not stained

Non protruding/unbroken

OTHER BEDDING REQUIREMENT

ROOM WALLS/CEILING

Not dirty/stained/wornout/torn

Clean/no peeling paint

OVERALL ROOM CLEANLINESS

Free of insects/rodents

No dust/dirt/liter/stains/cobwebs

Smoke detector

Active light switch at main entry to unit

At least one chair (in good condition)

Writing surface (in good condition)

A night stand or equivalent ( in good condition)

Sufficient lamps to properly illuminate the room for reading/writing

Clothes hanging facilities; drawers or clothes storage area

Telephone (functioning/direct dial or 24 hour switchboard)

Television (functioning)

Waste basket

Electrical Outlets (functioning)

NIH CLINICAL CENTER

NAME OF FACILITY:

ADDRESS:

DATE:

HOTEL EVALUATION CHECKLIST

Alarm/clock radio

Adequate space for one piece of luggage

Shades, draperies or blinds on all windows

Window covering effectively shut out light from outside

Heating system (functioning/reasonably quiet)

ROOM REQUIREMENTS

Primary lock on all doors/dead-bolt/all windows

Door has a viewport/window

OVERALL BATH AREA CLEANINESS/WALLS/CEILING

No hair/stains/odor/no peeling paint/free of defects such as cracks, holes or stains

Functioning/clean

No grout problems/cracks

SHOWER/TUB

Shower curtain/tub enclosure clean and free from tears and mildew

Adequate light fixture above vanity/mirror/electrical outlet convenient to mirror

Adequate water pressure/hot water

Air Conditioning system (functioning/reasonably quite)

Ordorless/Clean windows

ROOM CARPETING

Free of defects such as cracks, holes or stains

MATTRESS/BOX SPRINGS

PSSD:/6/18/2013

File details come from the government source that posted it. Updated .