# Practice scope approval checklist

Imperial Cleaning Inc | imperialcleaninginc.com

Planning only, not clinical guidance. Your practice’s qualified infection-prevention lead must approve procedures, products, training, responsibilities and exclusions before use.

Facility reviewer: ____________________
Review date: ____________________
Approved scope reference: ____________________
Excluded tasks: ____________________

| Zone | Decision for the practice | Approval |
| --- | --- | --- |
| Public areas | Define reception and waiting-area tasks | Practice lead |
| Clinical rooms | Identify authorized tasks and responsible staff | Qualified clinical reviewer |
| Products and equipment | Approve labels, compatibility and training requirements | Practice lead |
| Waste and sharps | Specify authorized handling and excluded streams | Practice lead |
| Patient information | Define privacy and no-touch boundaries | Practice lead |

Notes / exclusions:
____________________

Planning template only. Review with the responsible facility or project lead before use. Do not record passwords, alarm codes, patient information or other sensitive records.