Information

  • Assessment Location

  • Building:

  • Inspection conducted by:

  • Inspector Signature

  • Document No.

Cleanness

Courtyard / Patio

  • Ready to Inspect?

  • Outside walks free of litter?

  • Entrance glass clean?

  • Entrance floor mats clean?

  • Waste baskets and liners clean?

Building Exterior / Perimeter

  • Ready to Inspect?

  • Outside walk-way free of litter?

  • Waste baskets and liners clean?

  • Light fixtures bug free?

  • Clean of cob webs?

  • Clean of wasp nest?

Exterior Seating (i.e. Bleachers, picnic tables, dugout, etc)

  • Ready to Inspect?

  • Outside walk-way free of litter?

  • Waste baskets and liners clean?

  • Seating clean?

  • Clean of wasp nest/cob webs?

  • Exterior signage is clean?

Main Entrance

  • Ready to Inspect?

  • Enter the room number

  • Outside walks free of litter?

  • Entrance glass clean?

  • Entrance floor mats clean?

  • Inside floors clean?

  • Inside Walls clean?

  • Waste baskets and liners clean?

  • Picture frames on walls clean?

Waiting area / Reception area

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • White boards clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

Restroom #1

  • Ready to Inspect?

  • Enter the room number

  • Toilets clean?

  • Urinal clean?

  • Partitions clean?

  • Sinks clean and free of soap buildup?

  • Fixtures and drain pipes clean?

  • Mirrors clean?

  • Stainless steel polished?

  • Waste baskets and liners clean?

  • Floor clean?

  • Corners are clean?

  • Air vents clean?

  • Walls clean?

  • Supply adequately stock?

  • Shower walls and tile clean?

Restroom #2

  • Ready to Inspect?

  • Enter the room number

  • Toilets clean?

  • Urinal clean?

  • Partitions clean?

  • Sinks clean and free of soap buildup?

  • Fixtures and drain pipes clean?

  • Mirrors clean?

  • Stainless steel polished?

  • Waste baskets and liners clean?

  • Floor clean?

  • Air vents clean?

  • Walls clean?

  • Supply adequately stock?

  • Shower walls and tile clean?

Hallways

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Water fountain clean?

Lounge

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

Kitchenette / Pantry

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Air vents clean?

  • Appliances clean?

  • Sink and drains clean?

Stairs

  • Ready to Inspect?

  • Steps clean?

  • Landing clean?

  • Railings clean?

  • Walls clean?

  • Free of cob webs?

Elevator

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Ceiling & light fixtures (lenses) clean?

  • Area free of dust?

  • Air vents clean?

  • Elevator tracks clean?

Office # 1

  • Ready to inspect?

  • Enter the room number

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Telephone clean?

Office # 2

  • Ready to inspect?

  • Enter the room number

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Telephone clean?

Office # 3

  • Ready to inspect?

  • Enter the room number

  • Floors clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Telephone clean?

Classrooms #1

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Classrooms #2

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Classrooms #3

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Conference Room

  • Ready to Inspect?

  • Enter the conference room number or name

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Auditorium

  • Ready to Inspect?

  • Floors clean?

  • Are steps clean?

  • Railings clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

Study / Practice room #1

  • Ready to Inspect?

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Study / Practice room #2

  • Ready to Inspect?

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Labs #1

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Counter top sinks clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Labs #2

  • Ready to Inspect?

  • Enter the room number

  • Floors clean?

  • White boards clean?

  • Walls clean?

  • Area free of dust?

  • Waste baskets and liners clean?

  • Furniture clean?

  • Counter top sinks clean?

  • Air vents clean?

  • Windows and sills clean?

  • Blinds clean?

  • Door knobs clean / disinfected?

Stacks (library)

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Windows and sills?

  • Furniture clean?

  • Area free of dust?

  • Air vents clean?

Serving area

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Windows and sills?

  • Area free of dust?

  • Air vents clean?

  • Drains clean?

Dining area

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Windows and sills?

  • Furniture clean?

  • Area free of dust?

  • Air vents clean?

Fitness Centers & Gym

  • Ready to Inspect?

  • Floors clean?

  • Walls clean?

  • Windows and sills?

  • Furniture clean?

  • Fitness equipment?

  • Area free of dust?

  • Air vents clean?

  • Water fountain clean?

Custodial Closet

  • Ready to Inspect?

  • Floors clean?

  • Deep sink and drain clean?

  • Equipment stored properly?

  • Shelves organized adequately stocked?

  • Walls clean?

  • All chemicals stored below eye level?

  • All chemicals are properly label?

  • Area free of dust?

Custodial Equipment?

  • Ready to Inspect?

  • Brute and caddy clean and organized?

  • Vacuum clean?

  • Buffer clean?

  • Mop bucket and wringer clean?

  • Dust mop clean?

  • Safety goggles ready and accessible?

  • Safety gloves readily accessible?

Safety elements and compliance

  • Ready to Inspect?

  • Floor care: wet floor signs in use

  • Proper foot wear for job task?

  • Slips, Trips & Fall hazards?

  • Eye/face protection: safety glasses, goggles?

  • Hand protection: Disposable gloves, chemical resistant gloves

  • Proper labeling of containers?

  • Uniform: appearance & in compliance?

Maintenance related issues

  • Ready to Procced?

  • Lighting: Any light fixtures not working?

  • Ceiling: Any ceiling tiles to be replaced (Due to stains or other issues) ?

  • Walls: Any wall damage to be repaired?

  • Other maintenance related items to be addressed?

Notes: Please indicate anything else not covered through the inspection.

  • Your notes

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.