Inspection Record - Toilet Cleaners

• Conducted on

  Date

• Cleaners Name

• Prepared by

• Map Location
  Address

• Which Toilet

• Toilet rolls (no less than 60% in a cubicle)

  Yes

  No

  N/A

• Jumbo dispensers - Arms sliding/undamaged

  Yes

  No

  N/A

• Bowls/Cisterns Clean

  Yes

  No

  N/A

• Urinals Clean

  Yes

  No

  N/A

• Hand basins/taps Clean

  Yes

  No

  N/A

• Soap dispenser - Clean/filled/operational

  Yes

  No

  N/A

• Wall tiles/partitions/doors Clean

  Yes

  No

  N/A

• Floor tiles/Ceilings Clean

  Yes

  No

  N/A

• Cobwebs On The Ceiling

  Yes

  No

  N/A

• Showers Clean And Mould Free

  Yes

  No

  N/A

• Sharps container located

  Yes

  No

  N/A

• Exterior Walls And Surrounds In Good Shape And Clean

  Yes

  No

  N/A

• Extras

• Has appropriate PPE been used?

  Yes

  No

  N/A

• Work instruction followed?

  Yes

  No

  N/A

• Correct break times?

  Yes

  No

  N/A

Photos

• Insert all related photos

  Media

Cleaners signature

• Sign below

  Sign