Information

  • Document No.

  • Building Name:

  • Week Ending:

  • Inspector:

  • Lead Custodian:

Utility Specialist

  • Location:

  • Employee:

  • Entrances (Exterior) / Entradas (Exteriores)

  • Outside Windows and Sills

  • Doors / Puertas

  • Stairs / Escalones

  • Elevators

  • Trash Receptacles / Botes de Basura

  • Floor Finish/Carpet / Acabado de Piso/Alfombra

  • Gum / Chicle

  • Spot/Wet Mopping / Trapiar Manchas/Completamente

  • Walls / Paredes

  • Ceilings & Vents / Cielos y Ventilas

  • Vending Machines Tops / Maquinas de Ventas

Light Duty Specialist

  • Room #

  • Employee:

  • Trash Receptacles / Botes de Basura

  • large debris on floor / basuritas en el piso

  • Chalk Boards & Trays / Pizarones y Bandejas

  • High Dusting / Sacudir Areas Altas

  • Low Dusting / Sacudir Areas Bajas

  • Pencil Sharpener / Saca Puntas

  • Walls / Paredes

  • Baseboards / Rodapies

  • Doors & Frames / Puertas y Marcos

  • Windows & Sills/Ledges/Blinds / Ventanas y Marco/Alfeizares/Persianas

  • Ceilings & Vents / Cielo y Ventilas

  • Desk & Table Tops / Escritorios y Mesas

  • Chairs / Sillas

  • TV/VCR/Projectors / TV/VCR/Proyectores

  • Phones / Telephonos

  • Bookcases & Shelves / Libreros

  • Carpet Spots / Manchas en la Alfombra

Vacuum Specialist

  • Room #

  • Employee:

  • Under Desks & Trash Receptacles / Debajo Escritorios y Basureros

  • Vacuum Chalk Tray / Aspirar Bandejas de Jiz

  • Small Debris / Basuritas

  • Traffic Areas / Areas de Traffico

  • Corners & Edges / Escuinas y Orillas

  • Spot/Wet Mop / Trapiar Completamente

Restroom Specialist

  • Men's Restroom

  • Women's Restroom

  • Universal Restroom

  • Room #

  • Employee:

  • Water Fountains / Vevederos

  • Sinks & Faucets / Lavavos y Llaves

  • Dispensers Cleaned & Stocked

  • Trash Receptacles / Botes de Basura

  • Walls / Paredes

  • Showers & Faucets / Regaderas y Llaves

  • Mirrors / Espejos

  • Toilets & Urinals / Escusados Urinarios

  • Toilet seats- both sides / asientos ambos lados

  • Partitions / Divisiones

  • Ceilings & Vents / Cielo y Ventilas

  • low & high dusting / Sacudir areas bajas y altas

  • Floors -swept & mopped / Pisos barridos y trapiados

Utility Specialist

  • Location:

  • Employee:

  • Entrances (Exterior) / Entradas (Exteriores)

  • Outside Windows and Sills

  • Doors / Puertas

  • Stairs / Escalones

  • Elevators

  • Trash Receptacles / Botes de Basura

  • Floor Finish/Carpet / Acabado de Piso/Alfombra

  • Gum / Chicle

  • Spot/Wet Mopping / Trapiar Manchas/Completamente

  • Walls / Paredes

  • Ceilings & Vents / Cielos y Ventilas

  • Vending Machines Tops / Maquinas de Ventas

Light Duty Specialist

  • Room #

  • Employee:

  • Trash Receptacles / Botes de Basura

  • large debris on floor / basuritas en el piso

  • Chalk Boards & Trays / Pizarones y Bandejas

  • High Dusting / Sacudir Areas Altas

  • Low Dusting / Sacudir Areas Bajas

  • Pencil Sharpener / Saca Puntas

  • Walls / Paredes

  • Baseboards / Rodapies

  • Doors & Frames / Puertas y Marcos

  • Windows & Sills/Ledges/Blinds / Ventanas y Marco/Alfeizares/Persianas

  • Ceilings & Vents / Cielo y Ventillas

  • Desk & Table Tops / Escritorios y Mesas

  • Chairs / Sillas

  • TV/VCR/Projectors / TV/VCR/Proyectores

  • Phones / Telephonos

  • Bookcases & Shelves / Libreros

  • Carpet Spots / Manchas en la Alfombra

Vacuum Specialist

  • Room #

  • Employee:

  • Under Desks & Trash Receptacles / Debajo Escritorios y Basureros

  • Vacuum Chalk Tray / Aspirar Bandejas de jiz

  • Small Debris / Basuritas

  • Traffic Areas / Areas de Traffico

  • Corners & Edges / Escuinas y Orillas

  • Spot/Wet Mop / Trapiar Completamente

Restroom Specialist

  • Men's Restroom

  • Women's Restroom

  • Universal Restroom

  • Room #

  • Employee:

  • Water Fountains / Vevederos

  • Sinks & Faucets / Lavavos y Llaves

  • Dispensers Cleaned & Stocked

  • Trash Receptacles / Botes de Basura

  • Walls / Paredes

  • Showers & Faucets / Regaderas y Llaves

  • Mirrors / Espejos

  • Toilets & Urinals / Escusados y Urinarios

  • Toilet seats - both sides / asientos ambos lados

  • Partitions / Divisiones

  • Ceilings & Vents / Cielo y Ventilas

  • low & high dusting / Sacudir areas bajas y altas

  • Floors- swept & mopped / Pisos barridos y trapiados

Comments, Sigatures and Five Levels of Clean defined by APPA

  • Inspector Comments:

  • Rep Comments:

  • Inspector Signature:

  • Five Levels of Clean Defined by APPA

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