Title Page
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Site / Centre
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Conducted on
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Prepared by
Public Toilets
Male Toilets
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Sinks clean and free from lime scale and dirt
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Seats and seat covers clean
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Urinals clean and free of lime scale
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Bins emptied, liners replaced
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Mirrors clean
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Doors clean
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Vents cleaned
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Floor clean
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Toilet supply level OK
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Toilet paper full or sufficient
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Soap and hand dryers working
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Walls clean
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Soap replenished
Female Toilets
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Toilets clean
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Seats and seat covers clean
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Bins emptied, liner replaced
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Mirrors clean
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Doors clean
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Sanitary bins empty
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Floor clean
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Toilet supply level OK
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Toilet paper folded
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Sinks clean and free from lime scale and dirt
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Walks clean
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Soap replenished
Disabled Toilets
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Toilet bowls clean
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Seats clean
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Bin emptied, liners replaced
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Mirrors clean
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Doors clean
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Push and kick plates clean
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Floor clean
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Toilet supply level OK
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Hand basin and tap clean
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Walls clean
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Soap replenished
General
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Is the cleaners cupboard locked
Baby Changing Unit
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Baby changing unit clean
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Baby changing feeding room clean
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Bins emptied, liners replaced
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Mirrors clean
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Doors clean
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Paper roll full
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Floor clean
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Toilet supply level OK
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Wall clean
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Soap replenished
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Name of auditor