S02 - Attachment A DA 5105 Sample.pdf

This is a Janitorial Standards Checklist form (DA Form 5105) used to evaluate custodial services quality. The checklist provides a comprehensive evaluation framework for janitorial work across multiple areas of a facility, with rating standards of "Above," "Average," and "Below" for each task.

The form includes detailed categories for inspection including floors (mopping, sweeping, waxing, buffing), toilets (fixtures, bowls, seats), hallways/corridors (signs, doors, walls, hardware), entrances (rugs, radiators, kickplates), stairways (railings, landings), and miscellaneous areas (smoking stands, workrooms, locker rooms). Each category contains specific items to be evaluated, with particular attention to cleaning tasks like washing, dusting, and maintaining orderliness. The form appears to be associated with a VA janitorial services contract for the John H. Bradley VA Clinic in Appleton, WI, serving as a quality control tool for performance evaluation.