Clinic Closing Checklist Form
Document each step of your clinic’s end-of-day shutdown process. Please complete all required fields to ensure a secure and compliant closing.
Clinic Name
*
Department / Location / Branch
*
Date of Closing
*
-
Month
-
Day
Year
Date
Closing Time
*
Hour Minutes
AM
PM
AM/PM Option
Staff Member Completing Checklist
*
First Name
Last Name
Role / Job Title
*
Please Select
Nurse
Medical Assistant
Receptionist
Physician
Practice Manager
Other
Were all patient-facing areas cleaned and secured?
*
Yes
No
Not Applicable
Were all exam rooms reset and restocked?
*
Yes
No
Not Applicable
Were all medication and storage areas secured?
*
Yes
No
Not Applicable
Were sharps and biohazard waste disposed of properly?
*
Yes
No
Not Applicable
Was all equipment powered down and unplugged as required?
*
Yes
No
Not Applicable
Were lights, doors, alarms, and HVAC checked and set appropriately?
*
Yes
No
Not Applicable
Any incidents, issues, or items needing follow-up?
I confirm all closing tasks have been completed to the best of my knowledge.
*
Yes, I confirm
No, not all tasks were completed
Submit Checklist
Should be Empty: