House Cleaning List Template
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3DHS: Seniors and People with Disabilities
State Operated Community Program
House Cleaning List
Month / Year: _______________
Shift
Chores
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10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Empty dishwasher
Day
Swing
Prior to end of shift
Day
Check: Med / Mar’s /
Swing
TAR’s for accuracy
Night
Mop and sweep floors,
Day
prior to end of shift
Swing
Night
Empty trash cans
Day
Swing
Night
Wipe off counter tops
Day
and tables, prior to
Swing
end of shift
Night
Deep clean
Day
bathrooms: Each Shift
Swing
Night
Toilets, counters, sink, mop
Vacuum floors
Day
Swing
Laundry: Dry and Fold
Day
House/client laundry.
Swing
Alert next shift of laundry in
Night
washer/dryer.
Clean Adaptive
Day
Equipment.:
Swing
Follow
protocols for: wheel chairs,
Night
tables, Ankle Foot Orthotics
(AFO), etc.
Staff initials after chore has been completed (before end of shift)
0 = chore not done with explanation on back of form.
House Cleaning List _ Page 1 of 3
07/08
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Parent category: Business