Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Standard Instructions

  • Custodial Services is committed to attaining the highest level of service possible and have based our 3 levels of Cleanliness on the SCAA Canadian standard as mentioned in the Custodial Services Handbook.

    Level 1
    Floors and base molding shine and/or bright and clean. There is no build up in the corners or along walls. All vertical and horizontal surfaces have a freshly cleaned and polished appearance and have no accumulation of dust, dirt, marks, streaks, smudges, or fingerprints. Lights all work and fixtures are all clean. Washrooms and showers are clean and odor free. Supplies are adequate. Trash containers are emptied cleaned and odor free as per schedule.

    Level 2
    Floors and base molding shine and/or bright and clean. There is no build up in corners or along walls. But there can be up to two days’ worth of dust, dirt, stains, or streaks. All vertical and horizontal surfaces are clean, but marks, dust, smudges, or fingerprints are noticeable upon observation. Lights all work and fixtures are clean. Washrooms and showers are clean and odor free. Supplies are adequate. Trash containers are emptied cleaned and odor free as per schedule.

    Level 3
    Floors are swept or vacuumed clean, but are dull, dingy, and stained. There is a noticeable build up of dirt, dust, and/or floor finish in corners and along walls. Base moldings are dull and dingy with streaks or splashes. There is a dull, dirty path and/or obviously matted carpet in the walking lanes. All vertical and horizontal surfaces have conspicuous dust, dirt, marks, smudges, and fingerprints. Light fixtures are dirty, and some lights are burned out. Trash containers have not been emptied on a timely matter or per schedule. They are stained and marked. Trash containers smell sour. Lack of attention is obvious.

Johnson - Floor 0

RM-048 Entrance, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-046 Hallway, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-044 Hallway, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-043 Hallway, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-041 Hallway, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-040 Entrance, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-047 Stairs, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-028 Restroom, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-029 Restroom, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-026 Hallway, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-045 Stairs, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-042 Stairs, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-013 Restroom, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-014 Restroom, JOH-FLR0

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

Offices/Classrooms/Labs, JOH-FLR0

  • Which room?

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

Johnson - Floor 1

RM-180 Vestibule, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-161 Hallway, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-163 Hallway, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-165 Hallway, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-167 Entrance, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-159 Hallway, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-129 Restroom, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-170 Stairs, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-117 Vestibule, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-168 Vestibule, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-112 Restroom, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-110 Restroom, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-186 Stairs, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-162 Stairs, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-133 Vestibule, JOH-FLR1

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

Offices/Classrooms/Labs, JOH-FLR1

  • Which room?

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

Johnson - Floor 2

RM-248 Stairs, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-247 Hallway, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-246 Stairs, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-245 Hallway, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-243 Hallway, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-235 Shower, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures, air vents

  • Score the condition of the trash container

  • Score the cleanliness of the toilet (urinal if any), and sink

  • Score the cleanliness of the tub and showers

  • Are the shower curtains clean and/or the correct size?

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-233 Restroom, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-203C Vestibule, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

RM-240 Stairs, JOH-FLR2

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

Offices/Classrooms/Labs, JOH-FLR2

  • Which room?

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

Johnson - Floor 3

RM-330 Restroom, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the lights and light fixtures

  • Score the cleanliness of the toilet and sink

  • Score the condition of the trash container

  • Is there enough supplies (soap, toilet paper, hand paper)

RM-347 Stairs, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-346 Hallway, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-344 Stairs, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-343 Hallway, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-341 Hallway, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-340 Stairs, JOH-FLR3

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

Offices/Classrooms/Labs, JOH-FLR3

  • Which room?

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

Johnson - Floor 4

RM-430 Stairs, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-431 Stairs, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-425 Stairs, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

RM-423 Hallway, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-422 Hallway, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-421 Hallway, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-405 Hallway, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames

  • Score the cleanliness of the lights and light fixtures

RM-402 Laboratory, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

RM-404 Laboratory, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

RM-408 Collections Room, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

RM-409 Greenhouse, JOH-FLR4

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights, light fixtures and vents

  • Score the condition of the furniture (clean, organized, no damage)

  • Score the cleanliness of white and/or black board

  • Score the condition of the trash container and the recycling bin

RM-500 Stairs, JOH-FLR5

  • Score the cleanliness of the floor and base molding

  • Score the cleanliness of the vertical and horizontal surfaces

  • Score the cleanliness of the windows, window frames and screens

  • Score the cleanliness of the lights and light fixtures

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.