Patient Room:

Employee Name:

PT. Room #

1. Overbed Table Cleaned?

2. Night Stand Cleaned?

3. Phone Cleaned?

4. T.V Cleaned free of Dust?

5. Picture Frame free of Dust?

6. Overbed Light Cleaned free of Dust?

7. Closet Cleaned?

8. Walls Cleaned?

9. Vents Cleaned free of Lint?

10. Ceiling Cleaned?

11. Door Cleaned?

12. Door Handle Cleaned?

13. Door Frame Cleaned?

14. Waste Can Cleaned?

15. Floors Cleaned?

16. Cubicle Curtain Cleaned?

17. Cubicle Curtain Functional?

18. Room Organized?

Patient Restroom:

1. Toilet Bowl Cleaned?

2. Sink Cleaned?

3. Shower Cleaned?

4. Shower Curtain Cleaned?

5. Shower Curtain Functional ?

6. Supplies In Place?

7. Floors Cleaned?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.