Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Restroom facilities clean and sanitary
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Restroom facilities adequately stocked with the necessary supplies
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Staff lounge and eating areas clean and sanitary
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Drinking fountains clean and in good working order
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Work areas free of rodents and insects
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Ceiling fan blades safe and clean
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Waste receptacles emptied regularly
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Adequate type (tight-fitting covers where needed) and number of waste receptacles provided
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Storage areas clean and clear of debris or clutter
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Walls and woodwork clean
Signature
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Any other comments?
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When completed please provide signature here:
