Cleaning Shift Checkout Form
Please complete this form to verify the completion of your cleaning shift and document all relevant details.
Staff Full Name
*
First Name
Last Name
Shift Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Shift End Time
*
Hour Minutes
AM
PM
AM/PM Option
Areas Cleaned During This Shift (select all that apply)
*
Lobby
Restrooms
Offices
Hallways
Break Room
Other
Cleaning Tasks Completed
*
Rows
Completed
Not Needed
Trash Emptied
1
2
Floors Swept/Mopped
3
4
Surfaces Disinfected
5
6
Restrooms Cleaned
7
8
Supplies Restocked
9
10
Mirrors/Glass Cleaned
11
12
Cleaning Supplies Used (list all used)
Were there any issues or incidents during your shift? If yes, please describe.
All equipment and keys have been returned
*
Yes
No (please explain below)
Additional Comments or Notes
Supervisor Name
*
First Name
Last Name
Supervisor Review: Please rate the overall quality of the cleaning shift
*
1
2
3
4
5
Signature (Staff)
*
Submit Checkout
Submit Checkout
Should be Empty: