EVS Quality Inspections - Restroom/Locker Rooms

• Location/Room #
  Address

• Conducted on

  Date

• Manager Conducting Audit

• EVS Staff Member Assigned

Doors

• Frames and Top Edges

  PASS

  FAIL

  N/A

• Push Plates/Handles

  PASS

  FAIL

  N/A

• Hinges

  PASS

  FAIL

  N/A

• Door Surfaces

  PASS

  FAIL

  N/A

Walls/Wall Hangings

• Light Switches

  PASS

  FAIL

  N/A

• All walls free of spots and stains

  PASS

  FAIL

  N/A

• Mirrors - No Marks/Smears

  PASS

  FAIL

  N/A

• Light over the sink is free of dust

  PASS

  FAIL

  N/A

• Soap Dispensers full

  PASS

  FAIL

  N/A

• Fire strobe lights/Exit signs dust free

  PASS

  FAIL

  N/A

• Sharps containers checked and replaced if 3/4 full

  PASS

  FAIL

  N/A

Ceilings

• Vents are clean and free of dust on outsides

  PASS

  FAIL

  N/A

• Lights Clean

  PASS

  FAIL

  N/A

• No visible spots on ceilings/tiles

  PASS

  FAIL

  N/A

Horizontal Surfaces

• Counters

  PASS

  FAIL

  N/A

• Tops and sides of partitions - no spots or dust

  PASS

  FAIL

  N/A

• Shelves free of dust

  PASS

  FAIL

  N/A

• Tops of cabinets/pictures free of dust

  PASS

  FAIL

  N/A

Floors

• Floors clean

  PASS

  FAIL

  N/A

• No build-up in corners

  PASS

  FAIL

  N/A

• Baseboards are clean

  PASS

  FAIL

  N/A

Fixtures

• Sinks are clean - no stains or debris

  PASS

  FAIL

  N/A

• Toilet paper refilled

  PASS

  FAIL

  N/A

• Hand dryers/paper towel dipsensers full and no streaks

  PASS

  FAIL

  N/A

Restroom/Locker Rooms

• Tops of lockers free of dust

  PASS

  FAIL

  N/A

• Showers clean and free of hair/debris in drains

  PASS

  FAIL

  N/A

• Shower curtains clean and have been changed

  PASS

  FAIL

  N/A

MISC.

• All products have been restocked

  PASS

  FAIL

  N/A

• Garbage cans - clean, extra bags on side and relined

  PASS

  FAIL

  N/A

SIGN OFF:

• Employee Signature when available

  Sign

• Manager performing audit

  Sign

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