Title Page

  • Campus Location

  • Conducted on

  • Prepared by

  • Employee Name:

  • Room Location:

  • Date Marked:

  • Time Marked:

  • Cleaning Type

  • Date Inspected:

  • Time Inspected:

Yes = Completely Removed / No = Appeared Untouched

  • 1. Bathroom Light Switch

  • 2. Bathroom Door Knobs

  • 3. Toilet Faucet/handrail/handhold

  • 4. Head Wall Control (Discharge Only)

  • 5. Toilet Seat/ Porta Pottie

  • 6. Handle / Glass door

  • 7. Bedside Table/Cart/Tray (Discharge Only)

  • 8. Exam light / Monitor (Discharge Only)

  • 9. Telephone / Call light (Discharge Only)

  • 10. Chair in room

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.