Information

  • Conducted on

  • Prepared by

  • Client name

  • Branch name

  • Location map

Staffing details

  • Authorised strength

  • Total number of strength

  • Picture of the staff

Uniform grooming standard

  • Staff presented in full uniform

  • Remarks

  • Picture of the staff

  • Vaccination double dose certificate

  • Vaccinated badge and mask

  • Availablity of SOP

  • Picture of SOP

Office area

  • Entrance Glass clean and free from smudges

  • Office floors are free of stains and marks

  • Tables, printers are free from dust

  • The meeting room is clean and odorless

  • Meeting room tables and chairs are cleaned and organised

  • Walls clean and free of spots and stains

  • Window glass free of finger prints and spots

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

  • Floors are free of slip/trip/fall hazards

Bathroom

  • Bathroom is cleaned and odourless

  • Floors free of dirt, dust, litter including corners

  • Bathroom mirror is free of debris and streaking

  • Bathroom ventilation is working

  • The bathroom commode is clean and free of stains

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

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

  • Cubicles are present, clean, and secure

  • Commode chairs are clean and in good repair

  • Washroom checklist is presented and maintained regularly

  • Sufficient materials available at the site

Pantry

  • Is pantry without obstruction

  • The water dispenser is cleaned and away from wastebin

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

  • Refrigerator is clean and without odor

  • Walls clean and free of spots and stains

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

  • The washbasin is free of debris and cleaned

  • Floors are free of slip/trip/fall hazards

Fine & Rewards

  • Fine or Rewards

  • Reason for Fine or Rewards

  • MAX ID of the Staff

Conversation and signature

  • Name of the staff with max ID

  • Signature of the staff

  • Name of the client representative with employee ID

  • Signature of the client representative

  • Feedback and recommendations

  • Signature of the assessor

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.