Cleaning and Monitoring Log Form
Use this form to record and monitor cleaning tasks and checks with clarity and consistency.
Date of Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Activity
*
Hour Minutes
AM
PM
AM/PM Option
Area or Location Cleaned
*
Type of Cleaning Task
*
Please Select
Surface Cleaning
Disinfection
Trash Removal
Restocking Supplies
Equipment Cleaning
Other
Person Responsible
*
Type of Monitoring Check
*
Please Select
Visual Inspection
Surface Swab
Supply Level Check
Equipment Status
Other
Monitoring Outcome
*
Pass
Fail
Not Applicable
Issues Found
Actions Taken
Supervisor/Reviewer
Submit Log
Should be Empty: