CONFIRMED COVID-19 CASE DISINFECTION SHEET
NOT CLASSROOM OR OFFICE AREA
Confirmed Coronavirus case(s) have/ has been reported at
School Name
Date
/
Month
/
Day
Year
Date Reported
Affected Areas:
Auditorium
Lounge
Restrooms
Kitchen & Cafe
Gym
Pool
Library
Other
Room Name
Room Number
Disinfected By
Surface Disinfected
Yes
No
Appliances, Counters, Tables, Seats
Switches, Plates, Doorknobs, Handles
Vending Machines
Microphones/Podium
Athletic Equipment, Mats
Lockers, Locker Rooms
Prep Tables
Sinks/Faucets
Bleachers
Other Areas 1
Other Areas 2
Other Area 1
If applicable
Other Area 2
If applicable
Disinfect Start
-
Month
-
Day
Year
Date
Start Time
AM
PM
AM/PM Option
Disinfect End
-
Month
-
Day
Year
Date
Finish Time
Minutes
AM
PM
AM/PM Option
Building Manager Signature
Clear
Asst. Building Manager Signature
Clear
Preview PDF
Submit
Should be Empty: