USFSP - Custodial Services - Inspection Form

• Client

• Assessment Location

• Building:

• Inspection conducted by:

• Inspector Signature

  Sign

• Document No.

Multi Gender Room

• Ready to Inspect?

  Yes

  No

  N/A

• Toilets clean?

  Yes

  No

  N/A

• Urinal clean?

  Yes

  No

  N/A

• Partitions clean?

  Yes

  No

  N/A

• Sinks clean and free of soap buildup?

  Yes

  No

  N/A

• Fixtures and drain pipes clean?

  Yes

  No

  N/A

• Mirrors clean?

  Yes

  No

  N/A

• Stainless steel polished?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Floor clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Supply adequately stock?

  Yes

  No

  N/A

Main Entrance

• Ready to Inspect?

  Yes

  No

  N/A

• Outside walks free of litter?

  Yes

  No

  N/A

• Entrance glass clean?

  Yes

  No

  N/A

• Entrance floor mats clean?

  Yes

  No

  N/A

• Inside floors clean?

  Yes

  No

  N/A

• Inside Walls clean?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Picture frames on walls clean?

  Yes

  No

  N/A

Waiting area (2nd FL)

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

Hallway (2nd FL)

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Water fountain clean?

  Yes

  No

  N/A

Office # 2202

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Counseling Office # 2203

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Counseling Office # 2204

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Counseling Office # 2205

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Counseling Office # 2207

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Office # 2214

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Office # 2216

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Office # 2218

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Office # 2219

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Office # 2220

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Group Therapy # 2222

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Nurse Station?

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Exam Room # 2212

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Exam Room # 2213

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Exam Room # 2215

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Exam Room # 2217

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Lab # 2209

• Ready to inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Telephone clean?

  Yes

  No

  N/A

Diagnosis Room

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• White boards clean?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

• Waste baskets and liners clean?

  Yes

  No

  N/A

• Furniture clean?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Windows and sills clean?

  Yes

  No

  N/A

• Blinds clean?

  Yes

  No

  N/A

• Door knobs clean / disinfected?

  Yes

  No

  N/A

Custodial Closet (1st FL)

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Deep sink and drain clean?

  Yes

  No

  N/A

• Equipment stored properly?

  Yes

  No

  N/A

• Shelves organized adequately stocked?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• All chemicals stored below eye level?

  Yes

  No

  N/A

• All chemicals are properly label?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

Custodial Closet (2nd FL)

• Ready to Inspect?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

• Deep sink and drain clean?

  Yes

  No

  N/A

• Equipment stored properly?

  Yes

  No

  N/A

• Shelves organized adequately stocked?

  Yes

  No

  N/A

• Walls clean?

  Yes

  No

  N/A

• All chemicals stored below eye level?

  Yes

  No

  N/A

• All chemicals are properly label?

  Yes

  No

  N/A

• Area free of dust?

  Yes

  No

  N/A

Equipment?

• Ready to Inspect?

  Yes

  No

  N/A

• Brute and caddy clean and organized?

  Yes

  No

  N/A

• Vacuum clean?

  Yes

  No

  N/A

• Buffer clean?

  Yes

  No

  N/A

• Mop bucket and wringer clean?

  Yes

  No

  N/A

• Dust mop clean?

  Yes

  No

  N/A

• Safety goggles ready and accessible?

  Yes

  No

  N/A

• Safety gloves readily accessible?

  Yes

  No

  N/A

Notes: Please indicate anything else not covered through the inspection.

• Your notes