COVID-19 Protocol Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

• Visitors Log compliant and up to date with the following (Name, Date, Time, Phone#)

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Proper signage at entrances

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• At time of Inspection approximate number employees in store

• Sales Yes or No

  Yes

  No

Hygienic Control

• Employees witnessed properly wearing face coverings when in close proximity to customers or fellow employees?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customers witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Vendors witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Department cleaned and sanitized

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employee or Employees responsible for cleaning and sanitizing?

• Date and Time of Last inspection?

  Date

• Cleaning supplies readily available?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Cleaning protocols being followed?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Entrances and exits?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Aisles and hallways?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Bathrooms?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Kitchen/breakroom?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Copier Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Is Coffee Station in use?

  Yes

  No

• Are log sheets in compliant and stored electronically

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Conference Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Commonly touched areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Clean Supply Inventory

• Cloth Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disposable Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Gloves?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disinfection?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Wipes?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Hand Sanitizer?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

Distancing Control

• Customer practicing social distancing?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Employees practicing social distancing?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Plexiglas dividers in place (where applicable)?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Any more necessary? (Where not able to practice proper Social distancing)

  Yes

  No

• Number of Dividers Needed?

• Waiting rooms setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customer interaction areas setup for proper social distancing

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Offices setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Floors properly marked in high traffic areas?

  Select Yes Item Needs Attention Action corrected @ time of Audit N/A Reference

  • Yes
  • Item Needs Attention
  • Action corrected @ time of Audit
  • N/A
  • Reference

• Floor marking high traffic area

  

Vehicle Cleaning Protocols

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Department Signature

Pre Screening Protocol

• Thermometer in working order?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Question Sheet available and in a conspicuous spot?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Pre-Screening Protocol being followed and log sheets utilized and stored?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Service Department Signature

  Sign

• Service Yes or No

  Yes

  No

Hygienic Control

• Employees witnessed properly wearing face coverings when in close proximity to customers or fellow employees?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customers witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Vendors witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Department cleaned and sanitized?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employee or Employees responsible for cleaning and sanitizing?

• Date and Time of Last inspection?

  Date

• Cleaning supplies readily available?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Cleaning Protocols being followed?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Entrances and exits?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Aisles and hallways?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Bathrooms?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Kitchen/breakroom?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Is Coffee Station in use?

  Yes

  No

• Are log sheets in compliant and stored electronically

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Copier Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Conference Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Commonly touched areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Clean Supply Inventory

• Cloth Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disposable Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Gloves?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disinfection?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Wipes?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Hand Sanitizer?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

Distancing Control

• Customer practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employees practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Plexiglas dividers in place (where applicable)?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Any more necessary? (Where not able to practice proper Social distancing)?

  Yes

  No

• Number of Dividers Needed?

• Waiting rooms setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customer interaction areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Offices setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Floors properly marked in high traffic areas?

  Select Yes Item Needs Attention Action corrected @ time of Audit N/A Reference

  • Yes
  • Item Needs Attention
  • Action corrected @ time of Audit
  • N/A
  • Reference

• Floor marking high traffic area

  

Vehicle Cleaning Protocol

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Rental Vehicle Clean Protocol

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Pre Screening Protocol

• Thermometer in working order?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Question Sheet available and in a conspicuous spot?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Pre-Screening Protocol being followed and log sheets utilized and stored?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Department Signature

• Service Department Signature

  Sign

• Parts Yes or No

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Hygienic Control

• Employees witnessed properly wearing face coverings when in close proximity to customers or fellow employees?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customers witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Vendors witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Department cleaned and sanitized?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employee or Employees responsible for cleaning and sanitizing ?

• Date and Time of Last inspection?

  Date

• Cleaning supplies readily available?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Cleaning Protocols being followed?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Entrances and exits?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Aisles and hallways?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Bathrooms?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Kitchen?/breakroom?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Is Coffee Station in use? Are log sheets in compliant and stored electronically

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Copier Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Commonly touched areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Clean Supply Inventory

• Cloth Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disposable Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Gloves?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disinfection?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Wipes?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Hand Sanitizer?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

Distancing Control

• Customer practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employees practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Plexiglas dividers in place (where applicable)?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Any more necessary? (Where not able to practice proper Social distancing)?

  Yes

  No

• Number of dividers needed ?

• Waiting rooms setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customer interaction areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Offices setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Floors properly marked in high traffic areas?

  Select Yes Item Needs Attention Action corrected @ time of Audit N/A Reference

  • Yes
  • Item Needs Attention
  • Action corrected @ time of Audit
  • N/A
  • Reference

• Floor marking high traffic area

  

• Select Yes Item Needs Attention Action corrected @ time of Audit N/A Reference

  • Yes
  • Item Needs Attention
  • Action corrected @ time of Audit
  • N/A
  • Reference

Vehicle Cleaning Protocols

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Pre Screening Protocol

• Thermometer in working order?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Question Sheet available and in a conspicuous spot?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Pre-Screening Protocol being followed and log sheets utilized and stored?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Department Signature

• Parts Department Signature

  Sign

• Collision Yes or No

  Yes

  No

Hygienic Control

• Employees witnessed properly wearing face coverings when in close proximity to customers or fellow employees?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customers witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Vendors witnessed properly wearing face coverings?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Department cleaned and sanitized?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employee or Employees responsible for cleaning and sanitizing?

• Date and Time of Last inspection?

  Date

• Cleaning supplies readily available?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Cleaning Protocols being followed?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Entrances and exits?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Aisles and hallways?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Bathrooms?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Kitchen/breakroom?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Is Coffee Station in use?

  Yes

  No

• Are log sheets in compliant and stored electronically

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Copier Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Conference Room?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Commonly touched areas?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Clean Supply Inventory

• Cloth Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disposable Masks?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Gloves?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Disinfection?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Wipes?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

• Hand Sanitizer?

  Select Yes No N/A Supply Low

  • Yes
  • No
  • N/A
  • Supply Low

Distancing Control

• Customer practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Employees practicing social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Plexiglas dividers in place (where applicable)?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Any more necessary? (Where not able to practice proper Social distancing)?

  Yes

  No

• Number of Dividers Needed?

• Waiting rooms setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Customer interaction areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Common areas setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Offices setup for proper social distancing?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Floors properly marked in high traffic areas?

  Select Yes Item Needs Attention Action corrected @ time of Audit N/A Reference

  • Yes
  • Item Needs Attention
  • Action corrected @ time of Audit
  • N/A
  • Reference

• Floor marking high traffic area

  

Vehicle Cleaning Protocol

• Are log sheets in compliant and stored electronically?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Pre Screening Protocol

• Thermometer in working order?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Question Sheet available and in a conspicuous spot?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

• Pre-Screening Protocol being followed and log sheets utilized and stored?

  Select Yes Item Needs Attention N/A Action corrected @ time of Audit

  • Yes
  • Item Needs Attention
  • N/A
  • Action corrected @ time of Audit

Department Signature

• Service Department Signature

  Sign