An editable Client Home Cleaning and Disinfection Checklist for non-medical home care agencies.

For caregivers and supervisors who want a weekly record of routine cleaning and spill cleanup in each client’s home.

What’s included (5 pages; editable Word .docx):

• Pages 1-4: Part A client and week; Part B products used in this home; Part C each-visit tasks with daily initials; Part D weekly tasks; Part E body fluid spills and extra steps (E1 small spills, E2 spills with visible blood, E3 when someone in the home is sick); Part F sign-off
• Page 5: Agency Instructions page (remove before use)

How to customize:

1. Open the Word file and use Home > Replace > Replace All to change [Agency Name] to your agency’s name.
2. Replace [City] and [State] in the letterhead the same way; [Agency Name] also sits in the gray page header from page 2 on, so check it there.
3. Fill each [State] spot, list the products used in each home, and adjust the task rows to the client’s service plan.
4. Add your logo to the letterhead if you want one (there is no logo box), then delete the final Agency Instructions page before use.

Some lines cross-reference policy numbers from a companion Policy & Procedure Manual (sold separately); edit them to match your own policies.

Customizable template, not legal advice; check your state’s requirements. Not a license to operate, not HIPAA software, and no medical claims. It is not a clinical protocol, it is not a certification, and it does not promise that you meet any law or standard; review it against current public health guidance and your state’s rules before use.