Cleaning Efficiency Checklist

• Audit Title

• Client / Site / Hospital

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions:
  
  1. Answer "Compliant", "Non-Compliant", "N/A" for the questions below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Measure, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

Areas

• Walls

  Compliant

  Non-Compliant

  N/A

• Floors

  Yes

  No

  N/A

• All doors

  Compliant

  Non-Compliant

  N/A

• All internal glazing including partitions

  Compliant

  Non-Compliant

  N/A

• Low surfaces

  Compliant

  Non-Compliant

  N/A

• High surfaces

  Compliant

  Non-Compliant

  N/A

• Beds

  Compliant

  Non-Compliant

  N/A

• Lockers

  Compliant

  Non-Compliant

  N/A

• Tables

  Compliant

  Non-Compliant

  N/A

• Curtains and blinds

  Compliant

  Non-Compliant

  N/A

• Waste receptacles

  Compliant

  Non-Compliant

  N/A

• Electrical items

  Compliant

  Non-Compliant

  N/A

• Cleaning equipment

  Compliant

  Non-Compliant

  N/A

• Mirrors

  Compliant

  Non-Compliant

  N/A

• Showers

  Compliant

  Non-Compliant

  N/A

• Toilets

  Compliant

  Non-Compliant

  N/A

• Replenishment

  Compliant

  Non-Compliant

  N/A

• Baths

  Compliant

  Non-Compliant

  N/A

• Sinks

  Compliant

  Non-Compliant

  N/A

Observation – Correct Use of Equipment

• Are chemicals used correctly?

  Yes

  No

• Are mops and cloths used correctly to reduce cross-contamination?

  Yes

  No

• Are wastes disposed correctly?

  Yes

  No

• Auditor's Signature

  Sign