DNAP Housekeeping Rating Form

• Conducted on

  Date

• Prepared by

• Location
  Address

• A place is in order when there are no unnecessary things about and when all necessary things are in their proper places.
  It is mandatory to score each question in order to complete the checklist.

Aisles and Passage Ways

• Sufficient room for all movements

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Free of obstructions. e.g. filing cabinets, supplies, furniture etc.

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Stairwells and aisles properly lighted

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Steps kept clean, dry and free from obstructions

  Very Poor

  Poor

  Fair

  Good

  Excellent

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Electrical

• Not overloaded with extension cords or adaptors

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Electrical equipment have current test tag.

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• All lights are in working order

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• All fan heaters have current test tags and have timers fitted

  Very Poor

  Poor

  Fair

  Good

  Excellent

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Offices

• Not overloaded with extension cords or adaptors

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Filing cabinets are kept closed when not in use

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Confidential information is kept secure

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• General Office Rules are posted

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Common Area Rules and the Dress Code is posted

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Emergency response summary is posted and exit lights are working

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Fire extinguishers (position, number, test date and signage)

  Very Poor

  Poor

  Fair

  Good

  Excellent

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Lunchroom

• No spoiled food in refrigerator

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• No open food on counters

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Microwave and ovens clean

  Very Poor

  Poor

  Fair

  Good

  Excellent

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• Other general hygiene (dish cloths, dishes, spills etc)

  Very Poor

  Poor

  Fair

  Good

  Excellent

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General Comments

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