Information
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Document No.
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Building Name:
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Week Ending:
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Inspector:
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Lead Custodian:
Utility Specialist
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Location:
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Employee:
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Entrances (Exterior) / Entradas (Exteriores)
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Outside Windows and Sills
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Doors / Puertas
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Stairs / Escalones
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Elevators
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Trash Receptacles / Botes de Basura
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Floor Finish/Carpet / Acabado de Piso/Alfombra
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Gum / Chicle
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Spot/Wet Mopping / Trapiar Manchas/Completamente
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Walls / Paredes
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Ceilings & Vents / Cielos y Ventilas
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Vending Machines Tops / Maquinas de Ventas
Light Duty Specialist
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Room #
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Employee:
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Trash Receptacles / Botes de Basura
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large debris on floor / basuritas en el piso
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Chalk Boards & Trays / Pizarones y Bandejas
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High Dusting / Sacudir Areas Altas
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Low Dusting / Sacudir Areas Bajas
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Pencil Sharpener / Saca Puntas
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Walls / Paredes
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Baseboards / Rodapies
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Doors & Frames / Puertas y Marcos
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Windows & Sills/Ledges/Blinds / Ventanas y Marco/Alfeizares/Persianas
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Ceilings & Vents / Cielo y Ventilas
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Desk & Table Tops / Escritorios y Mesas
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Chairs / Sillas
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TV/VCR/Projectors / TV/VCR/Proyectores
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Phones / Telephonos
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Bookcases & Shelves / Libreros
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Carpet Spots / Manchas en la Alfombra
Vacuum Specialist
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Room #
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Employee:
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Under Desks & Trash Receptacles / Debajo Escritorios y Basureros
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Vacuum Chalk Tray / Aspirar Bandejas de Jiz
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Small Debris / Basuritas
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Traffic Areas / Areas de Traffico
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Corners & Edges / Escuinas y Orillas
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Spot/Wet Mop / Trapiar Completamente
Restroom Specialist
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Men's Restroom
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Women's Restroom
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Universal Restroom
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Room #
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Employee:
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Water Fountains / Vevederos
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Sinks & Faucets / Lavavos y Llaves
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Dispensers Cleaned & Stocked
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Trash Receptacles / Botes de Basura
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Walls / Paredes
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Showers & Faucets / Regaderas y Llaves
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Mirrors / Espejos
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Toilets & Urinals / Escusados Urinarios
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Toilet seats- both sides / asientos ambos lados
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Partitions / Divisiones
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Ceilings & Vents / Cielo y Ventilas
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low & high dusting / Sacudir areas bajas y altas
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Floors -swept & mopped / Pisos barridos y trapiados
Utility Specialist
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Location:
-
Employee:
-
Entrances (Exterior) / Entradas (Exteriores)
-
Outside Windows and Sills
-
Doors / Puertas
-
Stairs / Escalones
-
Elevators
-
Trash Receptacles / Botes de Basura
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Floor Finish/Carpet / Acabado de Piso/Alfombra
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Gum / Chicle
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Spot/Wet Mopping / Trapiar Manchas/Completamente
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Walls / Paredes
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Ceilings & Vents / Cielos y Ventilas
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Vending Machines Tops / Maquinas de Ventas
Light Duty Specialist
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Room #
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Employee:
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Trash Receptacles / Botes de Basura
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large debris on floor / basuritas en el piso
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Chalk Boards & Trays / Pizarones y Bandejas
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High Dusting / Sacudir Areas Altas
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Low Dusting / Sacudir Areas Bajas
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Pencil Sharpener / Saca Puntas
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Walls / Paredes
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Baseboards / Rodapies
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Doors & Frames / Puertas y Marcos
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Windows & Sills/Ledges/Blinds / Ventanas y Marco/Alfeizares/Persianas
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Ceilings & Vents / Cielo y Ventillas
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Desk & Table Tops / Escritorios y Mesas
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Chairs / Sillas
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TV/VCR/Projectors / TV/VCR/Proyectores
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Phones / Telephonos
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Bookcases & Shelves / Libreros
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Carpet Spots / Manchas en la Alfombra
Vacuum Specialist
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Room #
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Employee:
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Under Desks & Trash Receptacles / Debajo Escritorios y Basureros
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Vacuum Chalk Tray / Aspirar Bandejas de jiz
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Small Debris / Basuritas
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Traffic Areas / Areas de Traffico
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Corners & Edges / Escuinas y Orillas
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Spot/Wet Mop / Trapiar Completamente
Restroom Specialist
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Men's Restroom
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Women's Restroom
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Universal Restroom
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Room #
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Employee:
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Water Fountains / Vevederos
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Sinks & Faucets / Lavavos y Llaves
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Dispensers Cleaned & Stocked
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Trash Receptacles / Botes de Basura
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Walls / Paredes
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Showers & Faucets / Regaderas y Llaves
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Mirrors / Espejos
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Toilets & Urinals / Escusados y Urinarios
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Toilet seats - both sides / asientos ambos lados
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Partitions / Divisiones
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Ceilings & Vents / Cielo y Ventilas
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low & high dusting / Sacudir areas bajas y altas
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Floors- swept & mopped / Pisos barridos y trapiados
Comments, Sigatures and Five Levels of Clean defined by APPA
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Inspector Comments:
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Rep Comments:
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Inspector Signature:
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Five Levels of Clean Defined by APPA
