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Instructions/qualifications
Received special training and was certified within 12 months or less.
Information Page
Survey/Inspection details and requirements
Maintenance and testing is critical to the health requirements
Report Type
*
Scheduled inspection
Ad hoc inspection - per request
Repeat inspection (prior failure)
Date/Time of inspection
*
Inspection Report Prepared by
*
Employee/Badge #
*
Other personnel participating
Remarks/Notes (i.e reason for Ad-Hoc or Re-Inspection)
Equipment location*
Women's Office Bathroom
Men's Office Bathroom
Women's Warehouse Bathroom
Men's Warehouse Bathroom
Customer Service Bathroom
Inspection and repair
Inspect all toilet bowls, sinks, and urinals for damage and repair/replace all parts as necessary.
*
Yes
No
Check operation and adjust where necessary all: taps, flushers, and any other associated fittings, including tap washers.
*
Yes
No
Check, adjust/replace all toilet seats as necessary.
*
Yes
No
Check, replace or repair strainers in sinks and urinals.
*
Yes
No
Check all floor waste, to insure they contain water.
*
Yes
No
Enter replacement part number
Remove all associated trash on completion of work
*
Yes
No
Repair any minor damage.
None
List any minor repair work done
List repair work done
Report any other property related matters.
None
Description
If other, precise: