• Employee Name

  • EID #

  • Facility

  • location

  • Date

  • Prepared by

Cleaning Inspection


  • hand hygiene done properly

Waste & Restock Disposables

  • soap

  • lotion

  • sharps - change when 2/3 full

  • toilet paper

  • paper towels

  • wastebaskets emptied

General Cleaning Pathway - Bathroom

  • high dusting - including lights & vents

  • doorknob, door frame, hinges

  • light switches

  • nurse call light & cord

  • sink/faucet/handles/vanity

  • mirrors

  • spot clean walls

  • wipe garbage can inside and out

  • toilet (bottom to top)


  • hand hygiene done properly


  • rag changes sufficient

Floors & Service

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

  • dust mop floor with appropriate head

  • place wet floor sign

  • wet mop floor with microfiber mop head


  • hand hygiene done properly

  • look over room

  • work orders

General Comments

  • undefined

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.