Employee Name:

Room Location:

Date Marked:
Time Marked:

Cleaning Type

Date Inspected:
Time Inspected:
Yes = Completely Removed / No = Appeared Untouched

1. Light Switch

2. Door Handle

3. Overbed Table

4. Exam light / Monitor

5. Telephone / Call light

6. Chair in room

7. Sink Faucet Handle

8. Toilet Faucet/handrail/handhold

9. Toilet Seat

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.