Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Building:
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Inspector:
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Room #:
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Date:
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Ratings
Rate each item below yes or no based on whether or not it's condition meets the standards. For items that are not applicable for a particular area, leave that rating blank. -
Entry Door
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Comments
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Door Hardware
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Comments
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Lights
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Comments
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Vent
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Comments
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Ceiling
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Comments
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Walls
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Comments
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Windows
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Comments
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Mirrors
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Comments
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Towel Holders
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Comments
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Sinks/Fixtures
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Comments
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Soap Dispensers
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Comments
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Stalls
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Comments
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Commodes
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Comments
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Urinals
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Comments
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Floor
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Comments
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Waste Receptacle
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Comments
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Total Yes
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Total No
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Score:
(Yes Rating Total✖️100)➗(Yes Rating Total➕No Rating Total) = Score (%) -
Score =
