BUPA - Maroochydore

• Site Name

• Document No.

• Client/ Site Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Toilets

• Pans clean

  Yes

  No

  N/A

• Urinals clean

  Yes

  No

  N/A

• Hand basins and sinks clean.

  Yes

  No

  N/A

• Mirrors clean.

  Yes

  No

  N/A

• Consumables/dispensers clean.

  Yes

  No

  N/A

• Floors clean<br>

  Yes

  No

  N/A

• Doors/walls/partitions clean

  Yes

  No

  N/A

• Showers and baths clean.

  Yes

  No

  N/A

Internal rubbish

• Waste bins and liners.

  Yes

  No

  N/A

• Odour

  Yes

  No

  N/A

Kitchen /Canteen/

• Sinks and benches

  Yes

  No

  N/A

• Cabinets and appliances

  Yes

  No

  N/A

• Floors /walls /bins

  Yes

  No

  N/A

• Tables and chairs.

  Yes

  No

  N/A

• Stainless steel.

  Yes

  No

  N/A

Carpeted floors

• Traffic areas

  Yes

  No

  N/A

• Corners and edges.

  Yes

  No

  N/A

• Under furniture .

  Yes

  No

  N/A

• Spotting.

  Yes

  No

  N/A

Floors

• Sweeping /mopping /scrubbing.

  Yes

  No

  N/A

• Corners and edges.

  Yes

  No

  N/A

• Under furniture /rugs/mats

  Yes

  No

  N/A

Walls /doors/glass

• Doors/walls/light switches

  Yes

  No

  N/A

• Skirting boards

  Yes

  No

  N/A

• Partition glass baffle glass.

  Yes

  No

  N/A

• Windows external

  Yes

  No

  N/A

• Windows internal

  Yes

  No

  N/A

Low level(below 1.8 metres)

• Desks and tables

  Yes

  No

  N/A

• Office furniture /equipment .

  Yes

  No

  N/A

• Chairs.

  Yes

  No

  N/A

• Shelves/ledges.

  Yes

  No

  N/A

• Blackboards/whiteboards

  Yes

  No

  N/A

• Lockers /cabinets

  Yes

  No

  N/A

• Glass.

  Yes

  No

  N/A

High level (above 1.8 metres)light fitting

• Light fitting/fans

  Yes

  No

  N/A

• Ledges /sills.

  Yes

  No

  N/A

• Signage /picture frames

  Yes

  No

  N/A

• Air conditioners /vents

  Yes

  No

  N/A

• Glass

  Yes

  No

  N/A

Entrances and foyers

• Presentation .

  Yes

  No

  N/A

• Mats

  Yes

  No

  N/A

• Immediate surrounding.

  Yes

  No

  N/A

• Glass /aluminium /stainless steel

  Yes

  No

  N/A

External areas

• Tiled and paved areas

  Yes

  No

  N/A

• Grassed areas.

  Yes

  No

  N/A

• Refuse area.

  Yes

  No

  N/A

Other.

• Stairs/stairwells.

  Yes

  No

  N/A

• Corridors / walkways.

  Yes

  No

  N/A

• Cleaners room / storage.

  Yes

  No

  N/A

• Correct MSDS sheets in the Site Folder (must be GHS compliant and issued less than 5 years ago)

  Yes

  No

  N/A

• List of equipment

• Equipment Test and Tag

  Yes

  No

  N/A

• Last test Date

  Date

• Next test Date

  Date

• Site Folder onsite

  Yes

  No

  N/A

• Comment

• Attach all training photos

  Media

Authorisation signatures

• Site induction completed

  Yes

  No

  N/A

• Client Service Manager signature

  Sign

• Client Signature

  Sign