Audit

RESTROOM:
Public Restroom: 1

Location:

1. Toilet bowl / Plumbing fixtures clean?

2. Sink / Plumbing fixtures clean?

3. Mirriors clean?

4. Walls / Stalls clean?

5. Wastecans clean & freshly lined?

6. Floors clean / mopped?

7. Vents / Cieling clean?

8. Supplies in place?

Staff Restroom: 2

Location:

1. Toilet bowl / Plumbing fixtures clean?

2. Sink / Plumbing fixtures clean?

3. Mirriors clean?

4. Walls / Stalls clean?

5. Wastecans clean & freshly lined?

6. Floors clean / mopped?

7. Vents / Cieling clean?

8. Supplies in place?

ANCILLARY AREA:
WAITING/LOBBY ROOM:

Location:

1. Vents Cleaned?

2. Chairs?

3. Walls Cleaned?

4. Ledges Cleaned?

5. Floors Cleaned?

Ancillary Area: 1

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

Ancillary Area: 2

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

Ancillary Area: 3

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

Ancillary Area: 4

Location:

1. Cabinets Cleaned?

2. Counters Cleaned?

3. Sinks Cleaned?

4. Walls Cleaned?

5. Ceiling Cleaned?

6. Ledges Cleaned?

7. Vents Cleaned?

8. Wastecans Cleaned & Freshly Lined?

9. Supplies in Place?

10. Floors Cleaned?

FLOORCARE:
Floorcare: 1

Location:

1. Baseboard Cleaned?

2. Corners Cleaned?

3. Edges Cleaned?

4. Floors Finished / Carpet Clean?

Floorcare: 2

Location:

1. Baseboard Cleaned?

2. Corners Cleaned?

3. Edges Cleaned?

4. Floors Finished / Carpet Clean?

READINESS ROUNDS:

Disinfection wipe container lids closed and labeled correctly? Chemical Dispensing unit in working condition?

Eye Wash sheets properly dated? (Unblocked)

Hopper rooms clean and in order? (No unnecessary items)

Hopper Room locked when not in use?

Housekeeping carts clean and free of unnecessary item?

Cart Locked and put away when not in use?

Equipment clean? (Vacuums, buffers & carts)

Staff have knowledge of R.A.C.E. (Rescue Alarm Contain Extinguish) and P.A.S.S. (Pull Aim Squeeze Sweep.)?

Staff have knowledge of Dwell time for Disinfectant? (Name of Disinfectant)

Performex?

Clorox Hydrogen Peroxide?

Does staff have knowledge of SDS? What is SDS? (Safety Data Sheets) Where is the SDS information located?

P.P.E. Available? (Gloves, Goggles is there evidence of use?) Hand Hygiene Being Performed? (Observation of Evidence)

Staff have knowledge of location of Fire Pull Stations?

Green Trash & Red Bio Hazard carts cleaned & lined? (McClure Carts)

Hand Hygiene Being Performed? (Observation of Evidence)

Signature By:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.