Hospital Cleaning Audit Form
Assess hospital cleanliness, hygiene standards, and record corrective actions during your audit.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Full Name
*
First Name
Last Name
Department/Area Audited
*
Please Select
Emergency Room
ICU
Patient Ward
Operating Theater
Outpatient Clinic
Restrooms
Other
Cleaning Checklist Evaluation
*
Rows
Compliant
Partially Compliant
Non-Compliant
Floors cleaned
1
2
3
Surfaces disinfected
4
5
6
Waste disposed properly
7
8
9
Restrooms sanitized
10
11
12
Hand hygiene supplies available
13
14
15
Overall Cleaning Performance
*
1
2
3
4
5
Hygiene Compliance Observed
*
Fully Compliant
Partially Compliant
Non-Compliant
Were any issues or deficiencies found?
*
Yes
No
Describe Issues/Deficiencies (if any)
Are corrective actions required?
*
Yes
No
Additional Comments or Recommendations
Submit Audit
Should be Empty: