Restroom Assessment Checklist


*Please fill in ALL the fields

 

  1. Name (please denote Mr/Ms/Mrs/Dr)



  2. Contact Number



  3. Email Address



  4. Date of Assessment (DD/MM/YYYY E.g. 01/01/2010)



  5. Time of Assessment (HH:MMam/pm E.g. 12:00pm / 12:00am)



  6. Address of Assessment




    ENTRANCE

  7. There are prominent signages and the entrance looks clean

    Yes
    No


    HAND WASH AREA

  8. All the taps at the basin and hand dryers are in working condition

    Yes
    No

  9. The hand soap dispensers are filled and in working condition

    Yes
    No

  10. Overall, the hand wash area is clean and tidy, with no litter

    Yes
    No


    WATER CLOSET (WC) AREA

  11. The cubicle door is clean and free of graffiti

    Yes
    No

  12. The door lock and coat hook are intact and functional

    Yes
    No

  13. The toilet bowl seat and cover/squat pan is intact and stain free

    Yes
    No

  14. The WC flush/sensor flush is functional and free of dust and stain

    Yes
    No

  15. The toilet paper dispenser is intact and functional with toilet paper

    Yes
    No

  16. Sanitary bin (for ladies only, one in each cubicle) is clean, intact and lined with plastic bag

    Yes
    No
    N/A


    URINALS (FOR GENTS ONLY)

  17. The urinals are intact and functional without chokage

    Yes
    No
    N/A

  18. The urinal flush/ sensor flush is functional and free of dust and stain

    Yes
    No
    N/A

    GENERAL AREAS

  19. The floor, walls, wall tiles and ceiling are free from dust, stains and litter

    Yes
    No

  20. The lightings are intact and functional, and of appropriate brightness

    Yes
    No

  21. The toilet is odour free and the floor is dry

    Yes
    No

  22. Are there any other areas to improve on? (Please key in N/A if no improvements)



  23. Any other comments? (Please key in N/A if no comments)



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