PATIENT ROOM CLEANING & DISINFECTION CHECKLIST

Created by ChecklistGuro (https://checklistguro.com)

--- INITIAL ASSESSMENT & PREPARATION ---
[ ] Patient Room Number
[ ] Date of Cleaning
[ ] Start Time of Cleaning
[ ] Room Status (Prior to Cleaning) (Occupied, Vacant, Under Isolation, Scheduled for Discontinuation of Services)
[ ] Notes on Room Condition (e.g., spills, biohazards)
[ ] Type of Isolation (if applicable) (Contact, Droplet, Airborne, Protective Environment, None)
[ ] Photo of Room Condition (Before Cleaning - Optional)

--- ROOM ENTRY & SAFETY ---
[ ] PPE Donned? (Yes, No)
[ ] Room Status (Occupied/Vacant/Isolation) (Occupied, Vacant, Isolation)
[ ] Patient/Resident Information (if occupied)
[ ] Biohazard Risk Assessment? (Low, Moderate, High)
[ ] Entry Time
[ ] Room Number/Location

--- DUSTING & SURFACE CLEANING (HIGH TO LOW) ---
[ ] Dust Ceiling Fixtures (lights, vents) (Completed, Not Completed)
[ ] Dust Window Sills and Frames (Completed, Not Completed)
[ ] Dust Top of Furniture (dressers, nightstands) (Completed, Not Completed)
[ ] Wipe Down Wall Surfaces (if applicable) (Completed, Not Completed)
[ ] Wipe Down/Dust Blinds or Curtains (Completed, Not Completed)
[ ] Clean Picture Frames/Decorations (Completed, Not Completed)
[ ] Wipe Down Bed Frame (Completed, Not Completed)
[ ] Clean Baseboards (Completed, Not Completed)

--- DISINFECTION OF HIGH-TOUCH SURFACES ---
[ ] Disinfectant Used (Refer to approved list) (Bleach Solution, Quaternary Ammonium Compound, Hydrogen Peroxide, Other (Specify in LONG_TEXT))
[ ] If 'Other' disinfectant used, please specify:
[ ] Contact Time Achieved? (Yes, No)
[ ] If 'No' to Contact Time, explain why:
[ ] High-Touch Surfaces Disinfected (Check all that apply) (Bed Rails, Call Button/System, Doorknobs/Handles, Light Switches, Overbed Table, Window Sill/Latch, IV Pole, Remote Control, Other (Specify in LONG_TEXT))
[ ] If 'Other' High-Touch Surfaces, please specify:
[ ] Concentration of Disinfectant (if applicable)
[ ] Disinfection Start Time:

--- BATHROOM CLEANING & DISINFECTION ---
[ ] Toilet Bowl Condition (Pre-Cleaning) (Clean, Slightly Soiled, Moderately Soiled, Heavily Soiled)
[ ] Shower/Tub Condition (Pre-Cleaning) (Clean, Slightly Soiled, Moderately Soiled, Heavily Soiled)
[ ] Specific Issues Noted (e.g., mold, stains)
[ ] Sink Cleanliness (Clean, Slightly Soiled, Moderately Soiled, Heavily Soiled)
[ ] Disinfectant Used (Bathroom) (EPA-Registered Disinfectant 1, EPA-Registered Disinfectant 2, EPA-Registered Disinfectant 3, Other (Specify))
[ ] If 'Other' disinfectant selected, please specify:
[ ] Contact Time (Seconds)
[ ] Mirror Cleanliness (Clean, Slightly Soiled, Moderately Soiled, Heavily Soiled)
[ ] Cleaner Signature

--- FLOOR CLEANING ---
[ ] Floor Type: (Vinyl, Tile, Wood, Carpet)
[ ] Cleaning Method: (Mopping, Vacuuming, Autoscrubber)
[ ] Detergent Concentration (ppm):
[ ] Notes on Soil or Spills:
[ ] Rinsing Performed? (Yes, No)
[ ] Floor Dried? (Yes, No)
[ ] Area Covered (sq ft):

--- FINAL INSPECTION & DOCUMENTATION ---
[ ] Date of Cleaning
[ ] Time of Cleaning Start
[ ] Time of Cleaning End
[ ] Room Status After Cleaning (Ready for Patient, Isolation Cleaning Required, Equipment Malfunction â€“ Report to Maintenance)
[ ] Any Issues Encountered During Cleaning?
[ ] Concentration of Disinfectant Used (%),
[ ] Competency Check Completed? (Yes, No)
[ ] Cleaner Signature
[ ] Cleaner Name (Printed)

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