• Microzone leader name

  • Zone / Location
  • Conducted on

  • Inspector Name

Flooring Details

  • Floor category

  • Type of flooring

  • Cleaning date

  • Area coverage (sqm)

  • Cleaning activity


  • 1) Cleanliness : free from contamination

  • Please select root cause

  • 2) Cleanliness : free from stain

  • Please select root cause

  • 3) Shine

  • Please select root cause

  • 4) Equipment satisfactory to user

  • Please stated your unsatisfied experience to the equipment

Action Taken

  • Photo Before

  • Photo After

  • Inspector's Comment


User Satisfaction

  • Equipment handling

  • Result of floor maintenance

  • Any comment (please state)

  • User Signature

  • Inspectors Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.