HYGIENE ASSESSMENT

• Conducted on

  Date

• Prepared by

• Client name

• Branch name

• Location map
  Address

• Authorised strength

  Yes

  No

  N/A

• Total number of strength

• Picture of the staff

  Media

• Staff presented in full uniform

  Yes

  No

  N/A

• Remarks

• Picture of the staff

  Media

• Vaccination double dose certificate

  Media

• Vaccinated badge and mask

  Media

• Availablity of SOP

  Available

  Provided

• Picture of SOP

  Media

• Entrance Glass clean and free from smudges

  Yes

  No

  N/A

• Office floors are free of stains and marks

  Yes

  No

  N/A

• Tables, printers are free from dust

  Yes

  No

  N/A

• The meeting room is clean and odorless

  Yes

  No

  N/A

• Meeting room tables and chairs are cleaned and organised

  Yes

  No

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Window glass free of finger prints and spots

  Yes

  No

  N/A

• Ledges, window sils and shelves are free of dust and debris

  Yes

  No

  N/A

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Bathroom is cleaned and odourless

  Yes

  No

  N/A

• Floors free of dirt, dust, litter including corners

  Yes

  No

  N/A

• Bathroom mirror is free of debris and streaking

  Yes

  No

  N/A

• Bathroom ventilation is working

  Yes

  No

  N/A

• The bathroom commode is clean and free of stains

  Media

• The bathroom is stocked with soap, paper towels, and toilet tissue

  Media

• The sink is clean, free of soap and another buildup including any exposed piping

  Yes

  No

  N/A

• Cubicles are present, clean, and secure

  Yes

  No

  N/A

• Commode chairs are clean and in good repair

  Yes

  No

  N/A

• Washroom checklist is presented and maintained regularly

  Media

• Sufficient materials available at the site

• Is pantry without obstruction

  Yes

  No

  N/A

• The water dispenser is cleaned and away from wastebin

  Yes

  No

  N/A

• The micro oven is free from food particles and clean state

  Good

  Fair

  Poor

  N/A

• Refrigerator is clean and without odor

  Good

  Fair

  Poor

  N/A

• Walls clean and free of spots and stains

  Yes

  No

  N/A

• Flooring clean of dirt, dust, and litter including corners

  Yes

  No

  N/A

• The washbasin is free of debris and cleaned

  Media

• Floors are free of slip/trip/fall hazards

  Yes

  No

  N/A

• Fine or Rewards

  Fine

  Reward

  N/A

• Reason for Fine or Rewards

• MAX ID of the Staff

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• Yes

  No

  N/A

• Name of the staff with max ID

• Signature of the staff

  Sign

• Name of the client representative with employee ID

• Signature of the client representative

  Sign

• Feedback and recommendations

• Signature of the assessor

  Sign