Restroom Cleaning

• Employee Name

• EID #

• Facility

  Broadway

  SMCF

  South University

• location

• Date

  Date

• Prepared by

HAND HYGIENE

• hand hygiene done properly

  Yes

  No

Waste & Restock Disposables

• soap

  Yes

  No

  N/A

• lotion

  Yes

  No

  N/A

• sharps - change when 2/3 full

  Yes

  No

  N/A

• toilet paper

  Yes

  No

  N/A

• paper towels

  Yes

  No

  N/A

• wastebaskets emptied

  Yes

  No

  N/A

General Cleaning Pathway - Bathroom

• high dusting - including lights & vents

  Yes

  No

  N/A

• doorknob, door frame, hinges

  Yes

  No

  N/A

• light switches

  Yes

  No

  N/A

• nurse call light & cord

  Yes

  No

  N/A

• sink/faucet/handles/vanity

  Yes

  No

  N/A

• mirrors

  Yes

  No

  N/A

• spot clean walls

  Yes

  No

  N/A

• wipe garbage can inside and out

  Yes

  No

  N/A

• toilet (bottom to top)

  Yes

  No

  N/A

HAND HYGIENE

• hand hygiene done properly

  Yes

  No

RAG CHANGES

• rag changes sufficient

  Yes

  No

Floors & Service

• place clean liner in can with 2- 3 exra in the bottom

  Yes

  No

  N/A

• dust mop floor with appropriate head

  Yes

  No

  N/A

• place wet floor sign

  Yes

  No

  N/A

• wet mop floor with microfiber mop head

  Yes

  No

  N/A

HAND HYGIENE

• hand hygiene done properly

  Yes

  No

• look over room

  Yes

  No

  N/A

• work orders

  Yes

  No

  N/A

General Comments

• undefined