The scale for the following questions is ranked 1 for Completely Disagree to 10 for Completely Agree.

The grounds, landscaping and exterior are well kept.
The rest rooms are clean and well stocked.
Your work area is properly cleaned on a consistent basis.
The common areas inside the building are clean and well maintained.
The cleaning staff presents a professional appearance.
Overall, I am satisfied with the cleanliness of the building.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.