Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Personnel
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PERFORMANCE SCORES
Excellent = 5
Good = 4
Generally Acceptable = 3
Generally Unacceptable = 2
Poor = 1
OFFICES AND GENERAL AREAS
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Section Comments
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STAIRS
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Section Comments
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KITCHEN / VENDING AREAS
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Section Comments
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TOILETS / SHOWER AREAS
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Section Comments
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RECEPTION AREAS
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Section Comments
EXTERNAL AREAS
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Section Comments
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CLEANING CUPBOARD / ROOM
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Section Comments
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{A} TOTAL SCORE FOR AREA: 215
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{B} NUMBER OF ITEMS INSPECTED: 43
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{C} OVERALL AVERAGE SCORE (A/B):
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GENERAL COMMENTS ARISING FROM THE AUDIT
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Signature: Cleaning Manager
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Facilities Manager Attended
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Signature: Facilities Manager