Sample
Terminal clean, room 4-212
Sample hospital ยท
Verified to facility protocol v3
1 Room and time
- Room
- 4-212, medical / surgical
- Clean
- Terminal clean after discharge
- Isolation
- C. difficile
- Marked dirty
- by S. Okafor, EVS supervisor
- Started
- by R. Alvarez, EVS technician
- Approved
- by S. Okafor
Why it's here
A surveyor asks for a room and a date. The record answers with both, and with who started and approved the clean. Isolation status is part of the room because it decides which protocol loads.
2 Protocol
- Protocol
- Terminal clean, C. difficile isolation
- Version
- v3, in force from
- Loaded because
- Room flagged for C. difficile
- Requires
- 11 steps, 3 timed, 2 photos
- PPE
- Gown and gloves
Why it's here
Protocols change. The record names the version in force that night, so a March record is read against March's steps. Your facility writes the protocol; CleanZ runs the version you approved.
3 Products and contact times
- Product
- Sporicidal disinfectant (sample)
- EPA Reg. No.
- 12345-678 (sample)
| Timed step | Required | Timed | Result |
|---|---|---|---|
| High-touch surfaces | 4:00 | 4:00 | Met |
| Bed and rails | 4:00 | 4:00 | Met |
| Bathroom and fixtures | 4:00 | 4:00 | Met |
Why it's here
The timer comes from your product library, so the contact time on screen is the one for the approved product in use. The record keeps whether each timed step ran its full time. The product name and EPA number here are samples.
4 Steps and photos
- PPE on, isolation signage checkeddone
- Waste and linen removeddone
- Privacy curtain changeddone
- High-touch surfaces wiped12 pointsdone
- Bed and railsdone
- Mattress checkedException, resolveddone
- Bathroom and fixturesPhotodone
- Equipment wipeddone
- Floor, edges indone
- Final walk-throughPhotodone
- Room released for reviewdone
Why it's here
One line per step, in your protocol's order. The cleaner saw the same steps, one per screen. Photos are of surfaces, and only where the protocol asks for one.
5 Exceptions
- Logged
- by R. Alvarez
- Step
- Mattress checked
- Reason
- Mattress cover torn at the foot. Can't complete as written.
- Resolved
- , mattress replaced, by S. Okafor
Why it's here
When something outside the cleaner's control blocks a step, the reason goes on the record instead of a skipped step. The problem is visible, and it is not on the cleaner.
6 Rules check
- Required steps
- 11 of 11
- Required photos
- 2 of 2
- Contact times
- 3 of 3 timed steps met
- Open exceptions
- None
- Result
- Passed, submitted at
Why it's here
The room can't be submitted until every required item is there. The rules are your facility's settings, checked the same way every time. AI plays no part in pass or fail.
7 Review and rework
- Returned
- Sent back for rework at by S. Okafor
- Reason
- Bed rail, left side. This step needs another look: residue near the latch.
- Re-cleaned
- By R. Alvarez, contact time 4:00 met, photo attached. Resubmitted at .
Why it's here
A returned room keeps its first attempt, the reason it came back and the fix. An auditor wants failures kept, not only the final pass. The reason names the step, not the person.
8 Approval and seal
- Approved
- by S. Okafor, EVS supervisor
- Status
- Verified to facility protocol v3
- Sealed
- . Entries after this are added, never edited.
Why it's here
Approval seals the record. "Verified" always names the protocol it was verified against: it means your protocol was followed, and it makes no claim about the condition of a surface.
9 Spot test, added after approval
- Added
- by M. Chen, infection prevention
Fluorescent marker
- Surfaces marked
- 5, before the clean
- Marks removed
- 5 of 5
- Result
- Met the facility's acceptance criteria
ATP
- Surface
- Bed rail, left side
- Reading
- 118 RLU, photo of the meter attached
- Meter
- Sample meter, model A
- Threshold
- 250 RLU or lower, set by the facility for this model (sample value)
- Result
- Met the facility's acceptance criteria
Why it's here
Infection prevention runs spot tests on sampled rooms, not the cleaning team. Each result keeps its method, its device, the threshold that applied and who tested. CleanZ doesn't recommend thresholds; your facility sets one for each meter model.
10 Record history
- Room marked dirty S. Okafor, EVS supervisor
- Clean started, room tag scanned R. Alvarez, EVS technician
- Exception logged: mattress cover torn R. Alvarez
- Exception resolved: mattress replaced S. Okafor
- Rules check passed, room submitted R. Alvarez
- Returned for rework: bed rail, left side S. Okafor
- Re-cleaned and resubmitted R. Alvarez
- Approved, record sealed S. Okafor
- Spot test added M. Chen, infection prevention
Why it's here
Every entry has a time and a name, and nothing is written over. The history is how an auditor sees that the record was not tidied up after the fact.