Comprehensive Healthcare Cleanliness Report

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Personnel

1.0 - Door Entrances

• 1.1 - Windows cleaned inside and out?

  Yes

  No

  N/A

• 1.2 - Thresholds cleaned?

  Yes

  No

  N/A

• 1.3 - Mats cleaned and in proper place?

  Yes

  No

  N/A

• 1.4 - Is the condition of the mats good?

  Yes

  No

  N/A

• 1.5 - Cobwebs removed?

  Yes

  No

  N/A

• 1.6 - Walkways free of debris?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

2.0 - Corridors

• 2.1 - Floors dusted or carpet edges vacuumed?

  Yes

  No

  N/A

• 2.2 - Floors scrubbed and mopped or vacuumed?

  Yes

  No

  N/A

• 2.3 - Floors burnished or carpets cleaned?

  Yes

  No

  N/A

• 2.4 - Behind doors swept and cleaned?

  Yes

  No

  N/A

• 2.5 - Baseboards cleaned and dusted?

  Yes

  No

  N/A

• 2.6 - Corners cleaned?

  Yes

  No

  N/A

• 2.7 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• 2.8 - Cobwebs removed?

  Yes

  No

  N/A

• 2.9 - Water fountain cleaned?

  Yes

  No

  N/A

• 2.10 - Pull stations, extinguisher boxes, wall lights, etc. dusted?

  Yes

  No

  N/A

• 2.11 - Ledges dusted?

  Yes

  No

  N/A

• 2.12 - Bugs removed from light fixtures?

  Yes

  No

  N/A

• 2.13 - Spots removed from walls?

  Yes

  No

  N/A

• 2.14 - Windows cleaned in partitions at entrance to wings?

  Yes

  No

  N/A

• 2.15 - Gum removed?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

3.0 - Stairways

• 3.1 - Steps swept or vacuumed?

  Yes

  No

  N/A

• 3.2 - Steps mopped and rubber wiped down?

  Yes

  No

  N/A

• 3.3 - Rails and ledges dusted?

  Yes

  No

  N/A

• 3.4 - Cobwebs removed?

  Yes

  No

  N/A

• 3.5 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• 3.6 - Behind doors swept?

  Yes

  No

  N/A

• 3.7 - Walls cleaned?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

4.0 - Restrooms

• 4.1 - Floors swept?

  Yes

  No

  N/A

• 4.2 - Floors scrubbed?

  Yes

  No

  N/A

• 4.3 - Baseboards cleaned and dusted?

  Yes

  No

  N/A

• 4.4 - Corners swept and cleaned?

  Yes

  No

  N/A

• 4.5 - Walls cleaned?

  Yes

  No

  N/A

• 4.6 - Stalls and partitions cleaned?

  Yes

  No

  N/A

• 4.7 - Trash receptacle cleaned?

  Yes

  No

  N/A

• 4.8 - Stainless dispensers soap, paper towel, etc. cleaned and polished with stainless steel cleaner?

  Yes

  No

  N/A

• 4.9 - Sanitary boxes emptied?

  Yes

  No

  N/A

• 4.10 - Mirrors cleaned?

  Yes

  No

  N/A

• 4.11 - Toilets cleaned?

  Yes

  No

  N/A

• 4.12 - Urinals cleaned?

  Yes

  No

  N/A

• 4.13 - Chrome cleaned? (Do not use stainless polish)

  Yes

  No

  N/A

• 4.14 - Sinks cleaned?

  Yes

  No

  N/A

• 4.15 - Restrooms odor free?

  Yes

  No

  N/A

• 4.16 - Vents and ceiling tile dusted?

  Yes

  No

  N/A

• 4.17 - Grout cleaned?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

5.0 - Custodial Closets

• 5.1 Floors swept?

  Yes

  No

  N/A

• 5.2 - Floors mopped and cleaned?

  Yes

  No

  N/A

• 5.3 - Sinks cleaned?

  Yes

  No

  N/A

• 5.4 - Shelves and cabinets organized?

  Yes

  No

  N/A

• 5.5 - Mopheads cleaned?

  Yes

  No

  N/A

• 5.6 - Janitorial carts cleaned and organized?

  Yes

  No

  N/A

• 5.7 - Walls cleaned?

  Yes

  No

  N/A

• 5.8 - Mop buckets dumped after each shift?

  Yes

  No

  N/A

• 5.9 - Closet odor free?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

6.0 - Auditorium

• 6.1 - Trash removed?

  Yes

  No

  N/A

• 6.2 - Floors vacuumed?

  Yes

  No

  N/A

• 6.3 - Floors scrubbed/mopped?

  Yes

  No

  N/A

• 6.4 - Blinds dusted?

  Yes

  No

  N/A

• 6.5 - Window ledges dusted?

  Yes

  No

  N/A

• 6.6 - Cobwebs removed?

  Yes

  No

  N/A

• 6.7 - Wall cleaned?

  Yes

  No

  N/A

• 6.8 - Windows in and around classroom doors cleaned?

  Yes

  No

  N/A

• 6.9 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• 6.10 - Tables and counters swept under and free of debris?

  Yes

  No

  N/A

• 6.11 - Television dusted?

  Yes

  No

  N/A

• 6.12 - Projector and smart boards dusted?

  Yes

  No

  N/A

• 6.13 - Screens and maps dusted?

  Yes

  No

  N/A

• 6.14 - Bugs removed from light fixtures?

  Yes

  No

  N/A

• 6.15 - Counter behind computers dusted?

  Yes

  No

  N/A

• 6.16 - Storage room organized?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

7.0 - Meeting Rooms

• 7.1 - Windows inside and out cleaned?

  Yes

  No

  N/A

• 7.2 - Carpets vacuumed?

  Yes

  No

  N/A

• 7.3 - Ledges dusted?

  Yes

  No

  N/A

• 7.4 - Cobwebs removed?

  Yes

  No

  N/A

• 7.5 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

8.0 - Main Offices

• 8.1 - Trash removed on a schedule?

  Yes

  No

  N/A

• 8.2 - Carpets vacuumed?

  Yes

  No

  N/A

• 8.3 - Tables, counters, and furniture dusted?

  Yes

  No

  N/A

• 8.4 - Water fountains cleaned and disinfected?

  Yes

  No

  N/A

• 8.5 - Vents and ceiling tiles cleaned?

  Yes

  No

  N/A

• 8.6 - Cobwebs removed?

  Yes

  No

  N/A

• 8.7 - Blinds dusted?

  Yes

  No

  N/A

• 8.8 - Windows in and around office doors cleaned?

  Yes

  No

  N/A

• 8.9 - Window ledges dusted?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

9.0 - Dining Room

• 9.1 - Floors scrubbed and waxed?

  Yes

  No

  N/A

• 9.2 - Windows inside and out cleaned?

  Yes

  No

  N/A

• 9.3 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• 9.4 - Ledges dusted?

  Yes

  No

  N/A

• 9.5 - Cobwebs removed?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

10.0 - Mechanical Rooms

• 10.1 - Floors swept?

  Yes

  No

  N/A

• 10.2 - Drains free of debris?

  Yes

  No

  N/A

• 10.3 - Free of storage?

  Yes

  No

  N/A

• 10.4 - Door jams dusted?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

11.0 - Evaluation Rooms

• 11.1 - Floors swept?

  Yes

  No

  N/A

• 11.2 - Floors mopped?

  Yes

  No

  N/A

• 11.3 - Carpet vacuumed?

  Yes

  No

  N/A

• 11.4 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• 11.5 - Ledges dusted?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

12.0 - Multi-Purpose Room

• 12.1 -Trash removed?

  Yes

  No

  N/A

• 12.2 - Vents dusted?

  Yes

  No

  N/A

• 12.3 - Windows inside and out cleaned?

  Yes

  No

  N/A

• 12.4 - Thresholds cleaned?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

13.0 - Locker Rooms

• 13.1 - Floors swept?

  Yes

  No

  N/A

• 13.2 - Floors scrubbed?

  Yes

  No

  N/A

• 13.3 - Toilets cleaned?

  Yes

  No

  N/A

• 13.4 - Urinals cleaned?

  Yes

  No

  N/A

• 13.5 - Showers cleaned?

  Yes

  No

  N/A

• 13.6 - Sinks cleaned?

  Yes

  No

  N/A

• 13.7 - Mirrors cleaned?<br>

  Yes

  No

  N/A

• 13.8 -Corners cleaned?

  Yes

  No

  N/A

• 13.9 - Locker dusted?

  Yes

  No

  N/A

• 13.10 - Trash removed on a schedule?

  Yes

  No

  N/A

• 13.11 - Baseboards cleaned and dusted?

  Yes

  No

  N/A

• 13.12 - Walls cleaned?

  Yes

  No

  N/A

• 13.13 - Vents and ceiling tiles dusted?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

14.0 - Floor Equipment

• 14.1 - Vacuum bags dumped before they are full?

  Yes

  No

  N/A

• 14.2 - Buffer filter cleaned?

  Yes

  No

  N/A

• 14.3 - Scrubber recovery tank emptied after each use?

  Yes

  No

  N/A

• 14.4 - Equipment cleaned?

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

15.0 - Grounds

• 15.1 - Weeds removed from plant beds?

  Yes

  No

  N/A

• 15.2 - Trash receptacles emptied as needed?

  Yes

  No

  N/A

• 15.4 - Main side walks edged?

  Yes

  No

  N/A

• 15.5 - Campus trimmed?

  Yes

  No

  N/A

• 15.6 - Campus free of debris

  Yes

  No

  N/A

• Section Rating Scale

  Select Standard Above Standard Well Above Standard Superior Below Standard Unsatisfactory

  • Standard
  • Above Standard
  • Well Above Standard
  • Superior
  • Below Standard
  • Unsatisfactory

Comments

Sign Off

• Property Management Custodial Coordinator

  Sign

• Property Management Maintenance Team Lead

  Sign

• Property Management Supervisor

  Sign

• Date/Time

  Date