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Cleaning LogWebM2026-06-16T10:43:39+10:00

Cleaning Log

Ultraformer MPT Patient Consent Form

Δ

Name

First Last

Email

CLINIC DETAILS

Clinic Location(Required)

Month / Year(Required)

Responsible Staff Member(Required)

DAILY CLEANING CHECKLIST

Date(Required)

Daily Cleaning Tasks

Reception Area Cleaned

Treatment Beds Disinfected

Treatment Trolleys Cleaned

Door Handles Disinfected

Bathroom Cleaned

Floors Vacuumed / Mopped

Waste Removed

Linen Replaced

Hand Sanitiser Refilled

Sharps / Clinical Waste Checked (if applicable)

Staff Initials

TREATMENT ROOM DISINFECTION LOG

Date

Room Number / Name

Treatment Room Disinfection Tasks

Bed Disinfected Between Clients

Equipment Disinfected Between Clients

Handpieces Cleaned

Protective Covers Replaced

Surfaces Wiped With Approved Disinfectant

Staff Initials

EQUIPMENT MAINTENANCE LOG

Date

Equipment Name

Serial Number

Maintenance Performed

Service Required

Yes

No

Next Service Due

Staff Initials

LAUNDRY & LINEN LOG

Date

Laundry & Linen Tasks

Clean Linen Available

Used Linen Removed

Towels Washed

Treatment Covers Replaced

Staff Initials

INFECTION CONTROL CHECK

Date

Infection Control Items

Hand Hygiene Supplies Available

Gloves Available

Cleaning Products Available

PPE Available

No Infection Control Issues Identified

Comments

CORRECTIVE ACTIONS

Issue Identified

Action Taken

Completed By

Completion Date

MONTHLY REVIEW

Reviewed By

Review Date

Outstanding Issues

Actions Required

SIGNATURES

Staff Signature(Required)

Date(Required)

Manager Signature

Date(Required)

Contact Info

Level 1/42 East Concourse, Beaumaris, Vic 3193
Phone: 0448 892 914
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Open by Appointment

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