Title Page
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Healthcare Facility
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Address
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Department
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Hospital Housekeeper
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Conducted on
Hospital Housekeeping Checklist
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Unit
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Room Number
Before entering room
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Check isolation status
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Perform hand hygiene
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Don appropriate PPE
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Place wet floor sign in front of the door
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Check the sharps container (change if necessary)
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Empty and clean the trash container (handle plastic bags from the top)
Patient bed
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Raise and wipe down arm rails – high touch area
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Wipe foot of bed
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Discard the rag and proceed with a clean one after cleaning the bed
Move clockwise from the door and sanitize all equipment
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Ledges (below shoulder height)
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Door handles, knobs – high touch surfaces
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Light switches – high touch surfaces
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Call box – high touch surfaces
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Telephone – high touch surfaces
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Computer keyboard – high touch surfaces
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Window sills and ledges
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Soiled linen hamper lid
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In-room patient sink and faucet
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In-room soap dispenser and paper rag dispenser
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Biohazard can
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Dry erase marker
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Overbed table – high touch surfaces
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Patient chairs – high touch surfaces
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Bedside tables – high touch surfaces
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All other easily accessible wall mounted equipment
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Clean commode frame and seat cover last
Patient restroom
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Clean mirror with glass cleaner and wipe dry with a paper towel
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Light switches – high touch surfaces
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Door handles, knobs – high touch surfaces
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Hand rails – high touch surfaces
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Sink and sink counter – high touch surfaces
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Clean soap and paper towel dispensers
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Wipe shower or tub
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Spot walls
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Clean commode frame and seat cover
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Change rags before cleaning the toilet
Toilet
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Toilet paper dispenser
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Toilet flusher – high touch area
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Toilet seat – high touch area
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Under the bowl
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Toilet rim
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Clean inside of bowl with disinfectant cleaner and toilet brush
Before leaving room
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Remove gloves and perform hand hygiene
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Restock supplies
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Mop floor
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Perform hand hygiene
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Remove wet floor sign after the floor has dried
Completion
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Additional Comments
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Hospital Housekeeper Name & Signature
