Daily Cleaning and Personal Hygiene Inspection (COVID-19)

• Conducted on

  Date

• Prepared by

• Location
  Address

Cleaning and Disinfecting Surfaces

• Have you reviewed the cleaning measures to ensure that high risk contact areas and touch points are being regularly disinfected?

  Yes

  No

  N/A

• You should ensure that public surfaces such as counters, doorknobs, handles and light switches are regularly disinfected

• Have you followed CDC guidance for cleaning and disinfecting hard surfaces?

  Yes

  No

  N/A

Personal Protective Equipment (PPE) and Hand Hygiene

• Are staff members following the CDC recommended hand washing protocol?

  Yes

  No

  N/A

• Follow these five steps every time.
  
  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

• Are staff members wearing disposable gloves and gowns for all tasks in the cleaning process, including handling trash?

  Yes

  No

  N/A

• Gloves and gowns should be removed carefully to avoid contamination of the wearer and the surrounding area. Be sure to clean hands after removing gloves.

• Are staff members following normal preventive actions while at work including cleaning hands and avoiding touching eyes, nose, or mouth with unwashed hands?

  Yes

  No

  N/A

• Do you have readily available access to Hand Sanitizer for all staff members?

  Yes

  No

  N/A

• Does the Hand Sanitizer contain at least 60% alcohol content?

  Yes

  No

  N/A

• An alcohol-based hand sanitizer that contains 60%-95% alcohol should be used. However, if hands are visibly dirty, always wash hands with soap and water.

Employees

• Are all employees wearing their face shield?

  Yes

  No

  N/A

• Are all employees fully dressed in proper uniforms?

  Yes

  No

  N/A

• Are all staff trained on proper chemical handling, storage, and disposal?

  Yes

  No

  N/A

• Are all staff wearing appropriate PPE when handling chemicals?

  Yes

  No

  N/A

General Inspection of Facility

• Is the floor in the welfare area clean? (Should be last task at end of every day)

  Yes

  No

  N/A

• Is the facility clean and presentable?

  Yes

  No

  N/A

• Name & Signature

  Sign

Upstairs

• Is the floor clean?

  Yes

  No

  N/A

• Are toilets and urinals clean and sanitized?

  Yes

  No

  N/A

• Are all Sinks and Sink Faucets clean and sanitized?

  Yes

  No

  N/A

• Doors, Door Handles, Door Surfaces, Door Frames clean and sanitized?

  Yes

  No

  N/A

• Are all handrails clean and sanitized? ( Includes Employee Entrance Stairs)

  Yes

  No

  N/A

• Are all soap and sanitizer dispensers clean and sanitized?

  Yes

  No

  N/A

• Are the Microwave, Toaster and Coffee Maker clean and sanitized?

  Yes

  No

  N/A

• Are all the light switches clean and sanitized?

  Yes

  No

  N/A

• Is the lunch room table clean and sanitized?

  Yes

  No

  N/A

• Name & Signature

  Sign

Main Floor

• Is the floor clean?

  Yes

  No

  N/A

• Are toilets and urinals clean and sanitized?

  Yes

  No

  N/A

• Are all Sinks and Sink Faucets, Hose Bibs and Handles clean and sanitized?

  Yes

  No

  N/A

• Doors, Door Handles, Door Surfaces, Door Frames clean and sanitized?

  Yes

  No

  N/A

• Are all soap and sanitizer dispensers clean and sanitized?

  Yes

  No

  N/A

• Maintenance room workbench clean and sanitized?

  Yes

  No

  N/A

• Are all the light switches clean and sanitized?

  Yes

  No

  N/A

• Are all desk and table surfaces clean and sanitized?

  Yes

  No

  N/A

• Are all cart handles clean and sanitized? ( Grey and Blue)

  Yes

  No

  N/A

• Are all Pallet Jack handles clean and sanitized?

  Yes

  No

  N/A

• Is the Forklift Steering Wheel/ Control Handles clean and sanitized?

  Yes

  No

  N/A

• Name & Signature

  Sign

Comments and Sign-off

• Any comments or issues to report?

  Yes

  No

• Add comments or issues here:

• Overall rating

  Excellent

  Good

  Fair

  Poor

• Name & Signature

  Sign