A1/A2 Toilet Checklist

• Toilet Checklist

• Conducted on

  Date

• Prepared by

• Location

  A1

  A2

Level 11 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 10 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 9 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 8 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 7 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 6 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 5 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 4 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 3 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 2 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A

Level 1 (Please Take Pictures)

• Male Toilet

  Good

  Fair

  Poor

  N/A

• Female Toilet

  Good

  Fair

  Poor

  N/A

• Handicap Toilet

  Good

  Fair

  Poor

  N/A

• Any Defects on toilets?

  Yes

  No

  N/A