This form is used to inspect the cleanliness of a specific room in the building
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Location (room number):
Trash and Recycle Bins, available, emptied, clean?
Floors vacuumed and free of debris?
Carpet clean of stains, floors clean or scrapes/marks?
Space supplies filled?
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
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