Title Page
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INSPECTION DATE START
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WARD /AREA
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RISK LEVEL
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SUPERVISOR
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CLEANER PRESENT DURING THE INSPECTION
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CLEANER NAME AND SURNAME
OFFICE
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CP01 - DESK
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CP02 - TELEPHONE
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CP03 - MONITOR (TO BE CLEAN ONLY IF IT IS SWITCHED OFF)
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CP04 - KEYBOARD
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CP05 - SWITHCES
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CP06 - SHELVES
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CP07 - CUPBOARD
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CP08 - CHAIRS
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CP09 - SOAP / ALCOHOL DISPENSER
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CP10 - HAND TOWEL DISPENSER
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CP11 - SINK AND FIXTURES
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CP12 - BINS
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CP13 - FLOOR