NHS Vehicle Scheduled Weekly Clean
Report/Checklist
Vehicle Reg
*
Week Commencing
*
-
Month
-
Day
Year
Date
Cleaners Name
*
Outside Clean
*
Rows
Complete
Not Complete
N/A
All Panels
All Glass
Wheels & Wheel Arches
Mirrors
Lights
Number Plates
Door Handles
Cab Area
*
Rows
Complete
Not Complete
N/A
Headlining
Steering Wheel
Dashboard
Seats incl under seats
Seat belts
Doors/Bulkheads
Footwell
Floor
Telecommunication Device
*
Rows
Complete
Not Complete
N/A
Mobile Phones
Data Heads
Saloon Area
*
Rows
Complete
Not Complete
N/A
Ceiling
Walls
All Cupboards Facias
All Cupboard Interiors
Storage Trays/Boxes
Work Surfaces
Seats (all) including under
Seatbelts
Windows
Floor
Tail Lift/Ramp
Equipment
*
Rows
Complete
Not Complete
N/A
Stretcher
Carry Chair
Wheelchair
Transfer Board
Oxygen Bottle/ Regulator
Oxygen Flowmeter
Oxygen Outlet
Spill Kit
First aid kit
Additional Infomation
Other Cleaning Undertaken
Signed Completed
*
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Submit
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