ACU

• Assessment Location

• Building:

• Inspection conducted by:

• Inspector Signature

  Sign

• Document No.

Exterior

• Ready to Inspect?

  Yes

  No

  N/A

• Exterior lighting all operational?

  Yes

  No

  N/A

• Parking lot clean and free of trash and debris

  Yes

  No

  N/A

• Entrance glass clean?

  Yes

  No

  N/A

• Entrance floor mats clean?

  Yes

  No

  N/A

Building Exterior / Perimeter

• Ready to Inspect?

  Yes

  No

  N/A

• Outside walk-way free of litter?

  Yes

  No

  N/A

• Light fixtures bug free?

  Yes

  No

  N/A

• Clean of cob webs?

  Yes

  No

  N/A

• Clean of wasp nest?

  Yes

  No

  N/A

• Landscaping neat, trim and free of weeds and debris?

  Yes

  No

  N/A

Main Entrance

• Ready to Inspect?

  Yes

  No

  N/A

• Outside walks free of litter?

  Yes

  No

  N/A

• Entrance glass clean?

  Yes

  No

  N/A

• Entrance floor mats clean?

  Yes

  No

  N/A

• Inside floors clean?

  Yes

  No

  N/A

• Inside Walls clean?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Picture frames on walls clean?

  Yes

  No

  N/A

Waiting area / Reception area

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds/shades clean?

  Yes

  No

  N/A

Restroom - Men

• Ready to Inspect?

  Yes

  No

  N/A

• Toilets clean?

  Yes

  No

  N/A

• Urinal clean?

  Yes

  No

  N/A

• Partitions clean?

  Yes

  No

  N/A

• Sinks clean and free of soap buildup?

  Yes

  No

  N/A

• Fixtures and drain pipes clean?

  Yes

  No

  N/A

• Mirrors clean?

  Yes

  No

  N/A

• Stainless steel polished?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Paper products stocked?

  Yes

  No

  N/A

• Floor clean?

  Yes

  No

  N/A

• Corners are clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Supply adequately stock?

  Yes

  No

  N/A

Restroom -Women

• Ready to Inspect?

  Yes

  No

  N/A

• Is feminine product disposal container clean and does it have a clean liner"

  Yes

  No

  N/A

• Toilets clean?

  Yes

  No

  N/A

• Partitions clean?

  Yes

  No

  N/A

• Sinks clean and free of soap buildup?

  Yes

  No

  N/A

• Fixtures and drain pipes clean?

  Yes

  No

  N/A

• Mirrors clean?

  Yes

  No

  N/A

• Are paper products stocked?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Floor clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Supply adequately stock?

  Yes

  No

  N/A

• Is feminine product dispenser working?

  Yes

  No

  N/A

Hallways

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Water fountain clean?

  Yes

  No

  N/A

Conference Rooms

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Conference Room chairs and neatly arranged?

  Yes

  No

  N/A

• Furniture arranged neatly and ready for meetings?

  Yes

  No

  N/A

• Whiteboards clean?

  Yes

  No

  N/A

Break Area/Vending Area

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Counter tops clean?

  Yes

  No

  N/A

• Paper products stocked?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Appliances clean?

  Yes

  No

  N/A

• Refrigerator clean?

  Yes

  No

  N/A

• Sink and drains clean?

  Yes

  No

  N/A

• Lighting is all operational? No lights out?

  Yes

  No

  N/A

Stairs

• Ready to Inspect?

  Yes

  No

  N/A

• Steps clean?

  Yes

  No

  N/A

• Landing clean?

  Yes

  No

  N/A

• Railings clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Free of cob webs?

  Yes

  No

  N/A

Elevator

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Ceiling & light fixtures (lenses) clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Elevator tracks clean?

  Yes

  No

  N/A

Offices

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Cubicles

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets empty and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Are overhead bins and tops of cabinets dust-free?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Conference Rooms

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Janitorial Closets

• Ready to Inspect?

  Yes

  No

  N/A

• Brute and caddy clean and organized?

  Yes

  No

  N/A

• Shelves organized neatly with adequate stock?

  Yes

  No

  N/A

• Tools and equipment stored properly?

  Yes

  No

  N/A

• Chemicals properly labeled?

  Yes

  No

  N/A

• Vacuum clean?

  Yes

  No

  N/A

• Buffer clean?

  Yes

  No

  N/A

• Mop bucket and wringer clean?

  Yes

  No

  N/A

• Dust mop clean?

  Yes

  No

  N/A

• Safety goggles ready and accessible?

  Yes

  No

  N/A

• Safety gloves readily accessible?

  Yes

  No

  N/A

• Eye wash station available and not expired?

  Yes

  No

  N/A

• Sufficient stock of cleaning supplies and consummables?

  Yes

  No

  N/A

Maintenance Rooms

• Ready to Procced?

  Yes

  No

  N/A

• Chemical stored in proper containers and cabinets?

  Yes

  No

  N/A

• Storage shelves neatly organized with adequate stock?

  Yes

  No

  N/A

• Eye wash station available and not expired?

  Yes

  No

  N/A

• Are tools and equipment in good working condition and neatly organized?

  Yes

  No

  N/A

• Do the electrical rooms have proper caution boundaries outlined in fron of panels, no supplies stored in electrical room?

  Yes

  No

  N/A

• Lighting: Any light fixtures not working?

  Safe

  At Risk

  N/A

Notes: Please indicate anything else not covered through the inspection.

• Your notes