Hand Sanitizer Maintenance Checklist Form
Complete this checklist to track the inspection, refill, condition, and follow-up actions for each hand sanitizer station.
Inspection Tasks
Inspection Items (select all that apply):
*
Station is present and accessible
Station is clean and free of debris
No visible damage to dispenser
Dispensing mechanism operates smoothly
Refill Status (select all that apply):
*
Sanitizer level is sufficient
Refilled during this inspection
Refill needed soon
Condition Assessment (select all that apply):
*
Dispenser is securely mounted
No leaks or spills present
Signage is visible and legible
Follow-Up Actions Needed (select all that apply):
Repair required
Replacement part needed
Additional cleaning required
No follow-up needed
Additional Comments (optional)
Submit Checklist
Should be Empty: