Information

  • Document No.

  • Building

  • Address

  • 1. Not Cleaned
    2. Poorly Cleaned
    3. Some improvement needed
    4. Good
    5. Excellent

A. Toilets

  • Floors, Walls, Partitions

  • Remedial Action Required

  • Basins, Counters, Fittings, Mirrors

  • Remedial Action Required

  • Toilet Bowls, Seats, Lids, Urinals

  • Remedial Action Required

  • Showers

  • Remedial Action Required

  • Rubbish Removal, Refill Dispensers

  • Remedial Action Required

  • Door and Ceiling Grills

  • Remedial Action Required

  • Total Points Item A

B. OFFICE/ROOMS

  • Empty Bins, Replace Liners

  • Remedial Action Required

  • Carpets

  • Remedial Action Required

  • Walls, Doors, Glass, Windows

  • Remedial Action Required

  • Skills, Ledges, etc.

  • Remedial Action Required

  • Air Conditioning Diffusers, Vents,

  • Remedial Action Required

  • Furniture, Desks, Cabinets

  • Remedial Action Required

  • Total Points Item B

C. Staffroom/Kitchen/Pantry

  • Empty Bins, Rubbish Removal

  • Remedial Action Required

  • Carpets

  • Remedial Action Required

  • Hard Flooring

  • Remedial Action Required

  • Walls, Doors, Glass

  • Remedial Action Required

  • Appliance, Table Tops

  • Remedial Action Required

  • Sinks, Bench Tops, Tiles

  • Remedial Action Required

  • Total Points Item C

D. Lobbies, Public Areas

  • Carpets

  • Remedial Action Required

  • Hard Floors

  • Remedial Action Required

  • Lifts

  • Remedial Action Required

  • Rubbish Removal, Debris, Litter

  • Remedial Action Required

  • Internal Stairs

  • Remedial Action Required

  • Sills, Ledges, etc.

  • Remedial Action Required

  • Air Con Diffusers, Vents, Grills

  • Remedial Action Required

  • Walls, Doors, Glass, Windows

  • Remedial Action Required

  • Total Points Item D

E. External

  • Walkways, Paved Areas

  • Remedial Action Required

  • Walls, Under Roof, Eaves

  • Remedial Action Required

  • Rubbish Removal, Debris, Litter

  • Remedial Action Required

  • Total Points Item E

Total Score Items A to E

  • Assessment Rating % = Total Score Above X 100 = (Max possible Score 145)

Final

  • Client

  • Add signature

  • Select date

  • Contractor

  • Add signature

  • Select date

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