Attachment_3_Quality_Assurance_Surveillance_Monitoring_Form_Inspection_Sheet.pdf

Attachment 3. Quality Assurance Surveillance Monitoring Form Inspection Sheet

Date Performed

COR/PI

Task # Task Standard Frequency Satisfactory Unsatisfactory Comments

1.1.a Empty wastebaskets, replace liners. Remove trash to a designated area.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Daily

1.1.b Low dusting/cleaning of chairs, bookcases, desks, file cabinets, tables.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

1.1.c Clean and disinfect drinking fountains, sinks, countertops, tables, appliances, & glass surfaces

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Daily

1.1.d Clean restroom mirrors, shelves, dispensers, chrome fixtures and pipes

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Daily

1.1.e Wet mopping of tile floors in the office restrooms.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Daily

1.1.f Spot cleaning of carpets.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

1.1.g Sweep tile floors.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

1.1.h Vacuum carpets & rugs.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Daily

1.1.i Clean walk-off mats.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Daily

1.1.j Clean fixtures including water closets, urinals, and lavatories.

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Daily

1.1.k Service, inspect and replenish bathroom supply dispensers Dispensers are filled and sufficient to last through to the next cleaning. Daily

Acceptable Quality Level

Henry Mountains Office - Building 1

COR/PI

Task # Task Standard Frequency Satisfactory Unsatisfactory Comments

Acceptable Quality Level

1.1.l Wash foyer glass and glass in front glass door.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

1.1.m Keep sidewalks swept & clean.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Daily

1.1.n Service, inspect and replenish bathroom supply dispensers Dispensers are filled and sufficient to last through to the next cleaning. Daily

1.2.a Sweep janitor’s closet Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material 3x monthly

1.2.b

Wash and shine stalls & partitions.

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. 3x monthly

1.2.c Wash & shine metal entrance doors Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material 3x monthly

1.3.a Vacuum upholstered chairs.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Monthly

1.3.b Spot clean wall surfaces, door jambs, mop boards, thresholds & interior doors.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Monthly

1.3.c Sweep furnace/storage room

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Monthly

1.3.d High Cleaning/dusting Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Monthly

1.3.e Wash exterior windows Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Monthly

1.4.a Wash waste receptacles inside and out.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Semi-Anually

1.4.b Clean light fixtures & ceiling heat & AC vents. Should be free of bugs dirt and dust Semi-Anually

1.4.c Wash interior windows; remove objects on window sills, wall shelves and clean. Clean window blinds

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Semi-Anually

COR/PI

Task # Task Standard Frequency Satisfactory Unsatisfactory Comments

Acceptable Quality Level

2.1.a Empty wastebaskets, replace liners. Remove trash to a designated area.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Daily

2.1.b Remove sand from windows/sills.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

2.1.c Clean toilets, sinks, chrome fixtures and pipes.

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Daily

2.1.d Spot clean wall surfaces, doors and thresholds.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

2.1.e Sweep and spot clean floors.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

2.1.f Replenish toilet paper and soap in dispensers.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Daily

2.2.a Use pumice stone in toilet basins

Surfaces, inside/outside of toilet bowl, seat cover(s), and handles are clean/disinfected and free of scale, scum, mineral depoists, stains, streaks, and all foreign matter. Weekly

2.2.a Wash exterior doors – inside and out.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Monthly

2.2.b Wash windows Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Monthly

2.2.c

Sweep storage space.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Monthly

2.2.d Clean cement floors with wet broom or mop.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Monthly

2.3.a Wash trash receptacles inside and out.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Semi-Annually

2.3.b Remove, clean, and replace inside/outside light fixtures. Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Semi-Annually

Wolverton Mill Restrooms - Building 2

COR/PI

Task # Task Standard Frequency Satisfactory Unsatisfactory Comments

Acceptable Quality Level

3.1.a Empty wastebaskets, replace liners. Remove trash to a designated area.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Semi-Monthly

3.1.b Low dusting/cleaning of chairs, dressers and tables.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Semi-Monthly

3.1.c Clean and disinfect sinks, countertops, tables, appliances, & glass surfaces. Clean kitchen appliances.

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Semi-Monthly

3.1.d

Clean mirrors, shelves, toilet, bathtub and shower; wipe shower doors, chrome fixtures and pipes. Wash bathroom rugs as needed

Surfaces, metalic fixtures, sink, backsplashes, mirror, exposed pipes, electric dryer are clean/disinfected and free of dust, cobwebs, spots, stains, mold, encrustations, or excess moisture. Semi-Monthly

3.1.e Vacuum carpets.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Semi-Monthly

3.1.f Vacuum upholstered chairs & couch.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Semi-Monthly

3.1.g Spot clean wall surfaces, door jambs, and mop boards & thresholds.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Semi-Monthly

3.1.h Sweep/wet mop vinyl floors

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Semi-Monthly

3.1.i Spot clean carpets.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Semi-Monthly

3.1.j High Cleaning/dusting.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material Semi-Monthly

3.1.k Sweep sand out of door jambs, thresholds, off porches & sidewalks.

Surfaces are cleaned of spills, trash, foreign matter, dirt, dust, stains, spots, residue, debris, water puddles and streaks, mop marks, string gum, grease, tar, etc. Semi-Monthly

Henry Mountains Duplex - Building 3

COR/PI

Task # Task Standard Frequency Satisfactory Unsatisfactory Comments

Acceptable Quality Level

3.1.i Replenish paper towels, toilet paper, and trash bags.

Containers are emptied, liners replaced, and waste fixtures are cleaned. Semi-Monthly

3.1.j Remove, wash and replace mattress covers.

Surfaces are clean and free of dust, and other foreign material. Semi-Monthly

3.2.a Wash waste receptacles inside and out.

Containers are emptied, liners replaced, and waste fixtures are cleaned. semi-annually

3.2.b Clean light fixtures & ceiling AC vents. Should be free of bugs, dirt and dust Should be free of bugs, dirt and dust semi-annually

3.2.c Wash windows inside and out and clean sand/dirt out of window tracks.

Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material semi-annually

3.2.d Wash exterior doors – inside and out Surfaces are clean/disinfected, free of watermarks, scuffs, residue, and any other foreign material semi-annually