Daily Bathroom Checklist
Must be completed 30mins before your shift ends
Personnel Name
*
First Name
Last Name
Date & Time
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Please check the following areas/items for cleaning.
Rows
Men
Restroom
Women
Restroom
Notes (Please list any issues or concerns)
Toilet and toilet seats, disinfected wiped dry
1
2
Urinal handles cleaned, disinfected, wiped dry
3
4
Sink and fixtures cleaned, disinfected, wiped dry
5
6
Mirrors cleaned
7
8
Door handles, wall switches and other “high contact” areas cleaned, disinfected, wiped dry
9
10
Trash cans emptied and new liners put in place.
11
12
Floors free of paper and trash
13
14
Countertops, ledges, etc., cleaned, disinfected, wiped dry
15
16
Toilet tissue replenished
17
18
Shower area cleaned, disinfected, wiped dry
19
20
Restroom looks and smells clean
21
22
Personnel Signature
Submit
Should be Empty: