Training Manikin Cleaning Checklist Form
Document the completion and verification of training manikin cleaning after use.
Date of Cleaning
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location / Lab Area
*
Manikin Identifier
*
Training Session Reference
Cleaner Name
*
Cleaning Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Cleaning Completion Time
*
Hour Minutes
AM
PM
AM/PM Option
Cleaning Status
*
Completed
Incomplete
Cleaning Steps Checklist (mark all completed)
*
Exterior surfaces wiped with approved disinfectant
Airways and removable parts cleaned
Face and mouth area sanitized
Consumables replaced as needed
Manikin dried and stored properly
Damage or Issues Observed (if any)
Submit Checklist
Should be Empty: