Title Page
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Willingboro Urgent Care
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Date and Time of Inspection
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Inspected by
Offices, Waiting Area, Patient Rooms, Vestibule
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Stock towels, tissue, and hand soap
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Empty all trash receptacles and replace liners as needed
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Remove trash to a collection point
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Clean and polish drinking fountain/water cooler
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Thoroughly dust all horizontal surfaces, including desktops, files, windowsills, chairs, tables, pictures, and all manner of furnishings
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Damp wipe all horizontal surfaces to remove coffee rings and spillage
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Dust telephones
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Dust mop hard surface floors with a treated dust mop
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Damp mop hard surface floors to remove any spillage from soiled areas
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Damp wipe entryway and clean fingerprints from entrance glass
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Spot clean partition glass
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Inspect building entrance area
Restrooms
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Stock towels, tissue, and hand soap
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Empty sanitary napkin receptacles and wipe with a disinfectant
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Empty trash receptacles and wipe
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Clean and polish mirrors
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Wipe towel cabinet covers
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Toilets and urinals are cleaned and sanitized inside and outside
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Toilet seats are cleaned on both sides using a disinfectant
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Scour and sanitize all basins
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Dust partitions, top of mirrors and frames
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Remove splash marks from walls around basins
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Mop and rinse restroom floors with a disinfectant
Lunchroom
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Stock towels, tissue, and hand soap
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All trash receptacles are emptied and trash removed to a collection point
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Dust mop hard surface floors with a treated dust mop
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Damp mop hard surface floors to remove spillage from soiled areas
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Clean and wipe tables and chairs
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Spot clean walls near trash receptacles
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Clean fronts, tops, and sides of trash receptacles with a disinfectant
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Clean and polish drinking fountain/water cooler
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Damp wipe countertops to remove coffee rings and spillage
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Clean and sanitize sink
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Spot clean cabinets and exterior of appliances to present a neat appearance
Completion
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Recommendations
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Inspector's Full Name and Signature
