Title Page

  • Location

  • Conducted on

  • Prepared by

  • Take a picture of the restroom sign, restroom number, other identifier

  • Trash cans emptied

  • Paper towel, Toilet paper and seat covers adequately stocked

  • Soap dispensers stocked

  • Toilets / Urinals - Outside surfaces should be wiped down and clean including toilet seats

  • Underneath of toilet or urinal free from buildup or stains?

  • Clean the walls and partitions adjacent to the commodes and urinals

  • Mirrors wiped down - No streaks or residue

  • Clean sinks - Clean faucet / fixture, check drains and wipe down pipes

  • Mopped floors

  • Feminine Disposal container emptied

  • Clean floors - All loose trash and debris should be placed in the appropriate waste disposal container

  • Clean walls - No gum, stickers or graffiti etc.

  • Stainless steel trash cans, partitions and paper towel dispensers free of streaks / stains

  • Clean showers if applicable

Technician Notes

  • Add media

  • SCORE

Contractor Notes

Corrective Action for Failed Items

  • Add media

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