Facilities Services Custodial Inspection Form

• Custodian's Name (Last, First)

• School Site

• Building and Room Number

• Conducted on

  Date

• Prepared by

CUSTODIAL CLOSET

• Is assigned closet clean and organized?

  0

  1

  2

  N/A

• Approved chemicals stocked and NO unapproved chemicals stored?

  0

  1

  2

  N/A

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

  0

  1

  2

  N/A

• Cart equipment correct and organized?

  0

  1

  2

  N/A

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

  0

  1

  2

  N/A

DUSTING

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

  0

  1

  2

  N/A

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

  0

  1

  2

  N/A

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

  0

  1

  2

  N/A

• Horizontal Surfaces are clean and dust free?

  0

  1

  2

  N/A

• Phone has been wiped and clean?

  0

  1

  2

  N/A

CARPET

• Vacuuming of carpeted area?

  0

  1

  2

  3

  N/A

• Spot Cleaning of carpets has been completed as needed?

  0

  2

  4

  5

  N/A

• Edges and corners are clean?

  0

  1

  2

  N/A

WALLS

• Windows are clean and finger print free?

  0

  1

  2

  N/A

• Doors and frames are clean?

  0

  1

  2

  N/A

• Hand and fingerprints have been removed from the walls?

  0

  2

  3

  4

  N/A

• Splash marks have removed?

  0

  1

  2

  N/A

HARD FLOORS

• Type or area being inspected.

  Restroom

  Hallway

  Class Room

• Has the hard floor been swept clean?

  0

  1

  2

  N/A

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

  0

  1

  2

  N/A

• Are the threshold clean and free of debris?

  0

  1

  N/A

• Has the floor been moped?

  0

  1

  2

  N/A

• Have the scuff marks been removed?

  0

  1

  2

  3

  N/A

RESTROOMS

• Are the sinks and pipes clean?

  0

  1

  2

  N/A

• Are the toilets, urinals and hardware clean?

  0

  1

  2

  N/A

• Are the counter tops clean

  0

  1

  2

  N/A

• Are the walls and stall partitions clean?

  0

  1

  N/A

• Are the mirrors clean and streak free?

  0

  1

  N/A

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

  0

  1

  2

  N/A

TRASH

• Is the trash container clean?

  0

  1

  2

  3

  N/A

• Is the recycle container clean?

  0

  1

  2

  3

  N/A

• How is the placement of the containers?

  0

  1

  2

  N/A

• Has the trash and recycling been removed?

  0

  1

  2

  N/A

ROOM CONDITION

• Are the cabinets tops and drawers faces are clean?

  0

  1

  2

  N/A

• Are the marker board trays clean?

  0

  1

  2

  N/A

• Are the sinks clean?

  0

  1

  2

  N/A

• Is the exterior of any appliances clean?

  0

  1

  2

  N/A

• Are the door handles and surface clean?

  0

  1

  2

  N/A

ELEVATOR AND/OR STAIRS

• Are the tracks clean and free of debris?

  0

  1

  2

  N/A

• Are the steps clean?

  0

  1

  2

  N/A

• Are the rails and ledges clean?

  0

  1

  2

  N/A

• Is the ceiling clean?

  0

  1

  2

  N/A

• Is the bright metal clean and streak free?

  0

  1

  2

  N/A

FURNITURE

• Are the top surfaces clean?

  0

  1

  2

  N/A

• Are the side surfaces clean?

  0

  1

  2

  N/A

• Are the legs clean?

  0

  1

  N/A

• Are cabinets clean?

  0

  1

  N/A

• Are the chair fronts clean?

  0

  1

  2

  N/A

• Are the chair legs clean?

  0

  1

  N/A

• Are the chair backs clean?

  0

  1

  N/A

Signatures

• Additional Comments:

• Inspector

  Sign

• Custodian

  Sign