Run Patient Room Terminal Cleaning Verification — Free

Inspection Details

Room identifier and discharge turnover verified

Record the patient room number, unit, and discharge/turnover reference.

Inspection completed after discharge and before next patient placement critical (required)

Confirm the room was inspected after discharge and prior to re-occupancy.

Yes No N/A

Applicable terminal cleaning SOP followed

Confirm the inspection was performed against the facility terminal cleaning procedure and room turnover checklist.

Yes No N/A

Inspector name and role

Enter the inspector's name and title/role.

High-Touch Surface Cleaning

Bed rails, bed controls, and call button disinfected critical (required)

Check for complete cleaning of bed rails, controls, and patient call device.

Yes No N/A

Overbed table, bedside table, and chair arms disinfected critical (required)

Verify all patient-contact surfaces are clean and free of visible residue.

Yes No N/A

Door handles, light switches, and wall-mounted controls disinfected critical (required)

Confirm all frequently touched room-entry and room-control surfaces were cleaned.

Yes No N/A

Monitor surfaces, remote controls, and other shared devices disinfected

Verify any in-room shared equipment or device surfaces were cleaned per protocol.

Yes No N/A

No visible soil, dust, spills, or residue on high-touch surfaces critical (required)

Inspect all accessible high-touch points for remaining contamination or cleaning residue.

Yes No N/A

Cleaning/disinfection product contact time followed

Confirm the disinfectant was applied according to the label contact time and facility procedure.

Yes No N/A

Bed and Mattress Verification

Mattress surface clean and free of tears, cracks, or exposed foam critical (required)

Inspect the mattress for visible damage, staining, or compromised integrity.

Yes No N/A

Mattress cover or encasement intact and properly sealed critical (required)

Verify the mattress cover is intact, clean, and fully functional.

Yes No N/A

Bed frame, wheels, and under-bed area cleaned

Check the bed frame, casters, and accessible underside for cleanliness.

Yes No N/A

Pillow, linens, and disposable items removed or replaced as required critical (required)

Confirm all used linens and disposable items were removed and clean linens are in place if room is ready for occupancy.

Yes No N/A

Curtains and Soft Surfaces

Privacy curtains replaced or laundered per protocol critical (required)

Confirm curtains were changed out, laundered, or otherwise processed according to facility policy.

Yes No N/A

Curtain hooks, tracks, and touch points cleaned

Inspect curtain hardware and adjacent touch points for cleanliness.

Yes No N/A

Upholstery and fabric surfaces visibly clean

Verify any upholstered chair or fabric surface in the room is free of visible soil and stains.

Yes No N/A

UV-C Disinfection

UV-C cycle completed for required duration critical (required)

Confirm the UV-C device completed the full cycle per facility protocol.

Yes No N/A

UV-C device positioned and used according to manufacturer instructions critical (required)

Verify placement, room setup, and operation followed the device IFU and facility procedure.

Yes No N/A

Room was unoccupied and access controlled during UV-C operation critical (required)

Confirm no patients, visitors, or staff were exposed during the UV-C cycle.

Yes No N/A

UV-C cycle log or device record available

Verify documentation is available for the completed UV-C cycle, if required by protocol.

Yes No N/A

Final Room Readiness

Waste removed and sharps container not overfilled critical (required)

Check that waste was removed and any sharps container is secure and within fill limits.

Yes No N/A

Room free of odors, spills, and visible contamination critical (required)

Verify the room is clean, dry, and acceptable for patient occupancy.

Yes No N/A

Deficiencies documented and corrective actions assigned

Record any non-conformance and assign follow-up actions for re-cleaning or repair.

Yes No N/A

Inspector signature

Sign to confirm the inspection findings and room readiness determination.

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Run: Patient Room Terminal Cleaning Verification

Inspection Details

High-Touch Surface Cleaning

Bed and Mattress Verification

Curtains and Soft Surfaces

UV-C Disinfection

Final Room Readiness

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