Operating Room Cleaning Checklist 6l3s3m
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Terminal Cleaning Checklist OR / Procedure Room # _______
Date Cleaned _______
POLICY STATEMENT: The OR rooms are to be terminally cleaned and check list completed by the cleaning crew or center staff every night. The areas cleaned will be inspected by the OR staff assigned to each room prior to the start of cases the next day. This is to ensure the task has been completed and the appropriate level of terminal cleaning and disinfecting has taken place by those involved in the cleaning process. This is to be used as an evaluation tool to ensure the quality of the services we are providing and being provided and in turn providing to our patients is acceptable. PERFORMED BY: The cleaning company or center staff will perform terminal cleaning. The staff assigned to the room and general areas will check for completeness the next working day. The completed form if any deficiencies will be faxed to XYZ Cleaning or given to department manager for follow-up with those involved in the cleaning process. CLEANING TASK DESCRIPTION
TASK COMPLETE INITIALS OF PERSON CLEANING
INSPECTION INITIALS OF PERSON INSPECTING
1. Damp dust ceilings, AC returns/vents, fire sprinklers, ceiling, anesthesia plugs and gas outlets are cleaned and dusted. 2. Walls, doors, wall s, suction wall mounts, x-ray view boxes, gas s, wall outlets, and Fire Extinguisher cages are cleaned and dusted. 3. Glass, blinds, surface counters, cabinets, and all surfaces are cleaned, dusted, & spot free. 4. All furniture, metal tables, OR exam table, carts and unicels are thoroughly wiped down, clean and dusted. 5. Spotlights are cleaned and dusted. 6. Sub-sterile room autoclave and warmer are dusted and lint free, and the floor is mopped, cleaned, and spot free. 7. All equipment has been moved and the floor is thoroughly swept and mopped 8. Kick buckets and receptacles are cleaned and red bag liners replaced. 9. Laundry and trash collection frames and lids are wiped clean. 10. All trash and biohazardous waste has been removed and disposed of properly. Source: Lakeland Surgical & Diagnostic Center, Lakeland, Fla. Adapted and reprinted with permission.
Date Cleaned _______
POLICY STATEMENT: The OR rooms are to be terminally cleaned and check list completed by the cleaning crew or center staff every night. The areas cleaned will be inspected by the OR staff assigned to each room prior to the start of cases the next day. This is to ensure the task has been completed and the appropriate level of terminal cleaning and disinfecting has taken place by those involved in the cleaning process. This is to be used as an evaluation tool to ensure the quality of the services we are providing and being provided and in turn providing to our patients is acceptable. PERFORMED BY: The cleaning company or center staff will perform terminal cleaning. The staff assigned to the room and general areas will check for completeness the next working day. The completed form if any deficiencies will be faxed to XYZ Cleaning or given to department manager for follow-up with those involved in the cleaning process. CLEANING TASK DESCRIPTION
TASK COMPLETE INITIALS OF PERSON CLEANING
INSPECTION INITIALS OF PERSON INSPECTING
1. Damp dust ceilings, AC returns/vents, fire sprinklers, ceiling, anesthesia plugs and gas outlets are cleaned and dusted. 2. Walls, doors, wall s, suction wall mounts, x-ray view boxes, gas s, wall outlets, and Fire Extinguisher cages are cleaned and dusted. 3. Glass, blinds, surface counters, cabinets, and all surfaces are cleaned, dusted, & spot free. 4. All furniture, metal tables, OR exam table, carts and unicels are thoroughly wiped down, clean and dusted. 5. Spotlights are cleaned and dusted. 6. Sub-sterile room autoclave and warmer are dusted and lint free, and the floor is mopped, cleaned, and spot free. 7. All equipment has been moved and the floor is thoroughly swept and mopped 8. Kick buckets and receptacles are cleaned and red bag liners replaced. 9. Laundry and trash collection frames and lids are wiped clean. 10. All trash and biohazardous waste has been removed and disposed of properly. Source: Lakeland Surgical & Diagnostic Center, Lakeland, Fla. Adapted and reprinted with permission.
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