• Custodian's Name (Last, First)

  • School Site

  • Building and Room Number

  • Conducted on

  • Prepared by


  • Is assigned closet clean and organized?

  • Approved chemicals stocked and NO unapproved chemicals stored?

  • Vacuum bag is empty and vacuum condition is clean and working?

  • Cart equipment correct and organized?

  • Cart cloths and mops are in proper order and volume for assigned route?


  • High = Ledges and Vents are clean and dust free?

  • Low = Base and Corners are clean and dust free?

  • Vertical = Walls and Blinds are clean and dust free?

  • Horizontal Surfaces are clean and dust free?

  • Phone has been wiped and clean?


  • Vacuuming of carpeted area?

  • Spot Cleaning of carpets has been completed as needed?

  • Edges and corners are clean?


  • Windows are clean and finger print free?

  • Doors and frames are clean?

  • Hand and fingerprints have been removed from the walls?

  • Splash marks have removed?


  • Type or area being inspected.

  • Has the hard floor been swept clean?

  • Are the edges and corners clean and free of debris?

  • Are the threshold clean and free of debris?

  • Has the floor been moped?

  • Have the scuff marks been removed?


  • Are the sinks and pipes clean?

  • Are the toilets, urinals and hardware clean?

  • Are the counter tops clean

  • Are the walls and stall partitions clean?

  • Are the mirrors clean and streak free?

  • Is the hand soap and paper products supply sufficiently stocked?


  • Is the trash container clean?

  • Is the recycle container clean?

  • How is the placement of the containers?

  • Has the trash and recycling been removed?


  • Are the cabinets tops and drawers faces are clean?

  • Are the marker board trays clean?

  • Are the sinks clean?

  • Is the exterior of any appliances clean?

  • Are the door handles and surface clean?


  • Are the tracks clean and free of debris?

  • Are the steps clean?

  • Are the rails and ledges clean?

  • Is the ceiling clean?

  • Is the bright metal clean and streak free?


  • Are the top surfaces clean?

  • Are the side surfaces clean?

  • Are the legs clean?

  • Are cabinets clean?

  • Are the chair fronts clean?

  • Are the chair legs clean?

  • Are the chair backs clean?


  • Additional Comments:

  • Inspector

  • Custodian

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.