The ASC requires the cleaner to initial a checklist form indicating when each of 16 cleaning tasks are completed. These tasks includes scrubbing and cleaning sinks and counters, sweeping and mopping throughout the facility, and removal of trash and recycling
The surgery center also has a member of its staff confirm that each of the tasks were completed and pass inspection by initialing in a separate area on the form.
To download a sample copy of the general area cleaning checklist you can adapt for use in your ASC, click here (doc). To download a Spanish version of this checklist, click here (doc).
Learn more about Lakeland Surgical & Diagnostic Center.
Download other sample forms for adaptation and use in your ASC:
– Sample Medication Reconciliation Form
– Sample ASC Adult PONV/PDNV Policy
– Sample ASC Time-Out Policy and Procedure
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 18–20 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
