Information
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Client / Site
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Conducted on
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Prepared by
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Time In
Restrooms
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Clean
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Stocked
Exam Rooms
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Clean
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Exam beds
-
Trash emptied
Doctor Offices
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Clean
-
Trash emptied
Pain Management Injection Suite
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Clean
-
Trash emptied
Dictation Rooms
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Clean
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Keyboards Disinfected
Breakrooms
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Clean
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Trash emptied
Lobby
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Clean
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Front desk areas cleaned
Brace Store
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Clean
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Trash emptied
Security
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Alarm set
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Doors Locked
Non ISS Personnel
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Other People Working in Area
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Location
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Number of People
Maintenance Items
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Equipment Issues or Comments
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Add media
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Time Out
