1) Follow Work Safety
Yes
No
If no, Reason
Type here
2) Is there a Cob Web ?
Yes
No
If no, Reason
Type here
3) Exhaust Working
Yes
No
If no, Reason
Type here
4) AC Grill working
Yes
No
If no, Reason
Type here
5) Lights in proper condition
Yes
No
If no, Reason
Type here
6) Soap Dispenser working
Yes
No
If no, Reason
Type here
7) Mirror clean
Yes
No
If no, Reason
Type here
8) Taps & Fittings in proper condition
Yes
No
If no, Reason
Type here
9) Wash Basins in proper condition
Yes
No
If no, Reason
Type here
10) Hand Dryer in proper condition
Yes
No
If no, Reason
Type here
11) Water Closet in proper condition
Yes
No
If no, Reason
Type here
12) Water Closet Flush is working
Yes
No
If no, Reason
Type here
13) Health Faucet in proper condition
Yes
No
If no, Reason
Type here
14) Dust Bin is free form litter
Yes
No
If no, Reason
Type here
15) Water Closet Cubical and doors are clean
Yes
No
If no, Reason
Type here
16) Wall Tile is clean
Yes
No
If no, Reason
Type here
17) Floor is cleaned
Yes
No
If no, Reason
Type here
18) Floor Trap in proper condition
Yes
No
If no, Reason
Type here
19) Floor mats maintained properly
Yes
No
If no, Reason
Type here
CONSUMABLES AVAILABILITY
1) Toilet Roll
Yes
No
If no, Reason
Type here
2) Hand Wash
Yes
No
If no, Reason
Type here
3) Urinal Screener
Type here
4) Signature
Type here
