House Cleaning List Month / Year: .us
DHS: Seniors and People with Disabilities
State Operated Community Program
House Cleaning List
Chores
Empty dishwasher
Prior to end of shift Check: Med / Mar's / TAR's for accuracy
Shift 1 Day Swing Day Swing Night
Mop and sweep floors, prior to end of shift
Day Swing Night
Empty trash cans
Day Swing Night
Wipe off counter tops and tables, prior to end of shift
Day Swing Night
Deep clean bathrooms: Each Shift
Toilets, counters, sink, mop
Vacuum floors
Day Swing Night Day Swing
Laundry: Dry and Fold House/client laundry.
Alert next shift of laundry in washer/dryer.
Clean Adaptive Equipment.: Follow
protocols for: wheel chairs, tables, Ankle Foot Orthotics (AFO), etc.
Day Swing Night
Day Swing Night
Month / Year: _______________
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
House Cleaning List _ Page 1 of 3 Staff initials after chore has been completed (before end of shift) 0 = chore not done with explanation on back of form. 07/08
Cleaning chores
Wipe out fridge spills
Dust Wash wood work Inside ALL cabinets (laundry/Kitchen)
Vacuum furniture Vents Oven and burners Remove cob webs Supply/heater room Fridge remove drawers Wash inside windows Kitchen drawers (wipe) Under fridge/stove Walls Light fixtures Under washer/dryer Doors/frames/knobs Spot clean carpets Page reinforceres Exhaust fans Deep clean Assigned Individuals' bedroom
Shift 1
Day Swing Night Day Swing Night
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day Swing Night Day Swing Night Day Swing Night Day Swing Night Day Swing Night Day Day Swing
Initials Signature
Initials Signature
Initials Signature
Weekly: Site Managers signature: Verify chores
House Cleaning List _ Page 2 of 3 Staff initials after chore has been completed (before end of shift) 0 = chore not done with explanation on back of form. 07/08
Chore
Shift 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MISCELLANEOUS: Items to complete upon completion of assigned chores and assigned individual do not need assistance or is sleeping.
? Assist/help other staff
? Straighten closets
? Decorate for holidays
? Do the dishes
? Deep clean areas
? Reinforce pages in books
? Bake something
? Do house laundry
? Clean gutters
? Toss outdated/unmarked fridge food
? Do mending
? Clean light switches
? Rotate food in cupboards
? Turn in recycling
? Organize scrapbooks for clients
? Review clients' BSP
? Wash state vehicles
? Do crafts/projects for clients if pre-approved by management.
Activities limited to staff breaks: 2 (15 minutes) Management must be aware of scheduled breaks.
? Hand held games or laptop computer
? Personal knitting/crafting
? Personal paperwork or homework
? Watching TV
? Games not with client
? Relaxing with feet up
? Scrap booking (personal)
? Card playing
? Reading books, magazines, and newspapers
NEVER APPROVED for staff:
NO sleeping NO use of blankets/pillows NO loud music NO visitors/visiting staff NO horseplay NO lights off in living areas during evening/night hours.
Initials Signature
Initials Signature
Initials Signature
Weekly: Site Managers signature: Verify chores Date: Date: Date: Date:
House Cleaning List _ Page 3 of 3 Staff initials after chore has been completed (before end of shift) 0 = chore not done with explanation on back of form. 07/08
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