Housing Schedule Inspection Worksheet
Inspection Date:
/
Month
/
Day
Year
Date
Building & Floor(s):
Inspector:
Employee(s):
APPA Cleaning Levels
Leve 1 Orderly Spotlessness Level 2 Ordinary Tidiness Level 3 Casual Inattention Level 4 Moderate Dinginess Level 5 Unkempt Neglect
Rest Room Area
Take Photo
Restroom Area: Floor #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Toilet Seat
Please Select
1
2
3
4
5
NA
Comments
Flush Valve
Please Select
1
2
3
4
5
NA
Comments
Outside Bowl
Please Select
1
2
3
4
5
NA
Comments
Inside Bowl
Please Select
1
2
3
4
5
NA
Comments
TP Dispenser
Please Select
1
2
3
4
5
NA
Comments
Partitions/Door/Latches
Please Select
1
2
3
4
5
NA
Comments
Sink Faucets
Please Select
1
2
3
4
5
NA
Comments
Sink Drain
Please Select
1
2
3
4
5
NA
Comments
Under Sink
Please Select
1
2
3
4
5
NA
Comments
Supply Pipes
Please Select
1
2
3
4
5
NA
Comments
Soap Dispenser
Please Select
1
2
3
4
5
NA
Comments
Hand Dryer
Please Select
1
2
3
4
5
NA
Comments
Shower Walls
Please Select
1
2
3
4
5
NA
Comments
Showerhead
Please Select
1
2
3
4
5
NA
Comments
Shower Drain
Please Select
1
2
3
4
5
NA
Comments
Soap Dish
Please Select
1
2
3
4
5
NA
Comments
Walls
Please Select
1
2
3
4
5
NA
Comments
Vents
Please Select
1
2
3
4
5
NA
Comments
Floor
Please Select
1
2
3
4
5
NA
Comments
Mirrors/Frames
Please Select
1
2
3
4
5
NA
Comments
Door Louvers
Please Select
1
2
3
4
5
NA
Comments
Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Restroom Area)
Please Select
1
2
3
4
5
NA
Overall Comments (Restroom Area)
Hallway
Take Photo
Hallway: Floor #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Hallway: Walls
Please Select
1
2
3
4
5
NA
Comments
Hallway: Dust Ledges
Please Select
1
2
3
4
5
NA
Comments
Hallway: Mirrors
Please Select
1
2
3
4
5
NA
Comments
Hallway: Door Louvers
Please Select
1
2
3
4
5
NA
Comments
Hallway: Fountain
Please Select
1
2
3
4
5
NA
Comments
Hallway: Window Sills
Please Select
1
2
3
4
5
NA
Comments
Hallway: Fire Ext. Case
Please Select
1
2
3
4
5
NA
Comments
Hallway: Push Plates
Please Select
1
2
3
4
5
NA
Comments
Hallway: Floor
Please Select
1
2
3
4
5
NA
Comments
Hallway: Light Fixture
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Hallway)
Please Select
1
2
3
4
5
NA
Overall Comments (Hallway)
Laundry Room
Take Photo
Laundry Room: Floor #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Laundry Room: Sink
Please Select
1
2
3
4
5
NA
Comments
Laundry Room: Floor
Please Select
1
2
3
4
5
NA
Comments
Laundry Room: Behind Washers
Please Select
1
2
3
4
5
NA
Comments
Laundry Room: Behind Dryers
Please Select
1
2
3
4
5
NA
Comments
Laundry Room: Walls
Please Select
1
2
3
4
5
NA
Comments
Laundry Room: Vents
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Laundry Room)
Please Select
1
2
3
4
5
NA
Overall Comments (Laundry Room)
Entrance:
Take Photo
Entrance: Walls
Please Select
1
2
3
4
5
NA
Comments
Entrance: Dust Ledges
Please Select
1
2
3
4
5
NA
Comments
Entrance: Mirrors
Please Select
1
2
3
4
5
NA
Comments
Entrance: Door Louvers
Please Select
1
2
3
4
5
NA
Comments
Entrance: Fountain
Please Select
1
2
3
4
5
NA
Comments
Entrance: Window Sills
Please Select
1
2
3
4
5
NA
Comments
Entrance: Fire Ext. Case
Please Select
1
2
3
4
5
NA
Comments
Entrance: Push Plates
Please Select
1
2
3
4
5
NA
Comments
Entrance: Floors
Please Select
1
2
3
4
5
NA
Comments
Entrance: Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Entrance: Lobby Glass
Please Select
1
2
3
4
5
NA
Comments
Entrance: Threshold
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Entrance)
Please Select
1
2
3
4
5
NA
Overall Comments (Entrance)
Study Lounges
Take Photo
Study Lounge: Floor #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Study Lounge: Floor
Please Select
1
2
3
4
5
NA
Comments
Study Lounge: Furniture
Please Select
1
2
3
4
5
NA
Comments
Study Lounge: Vent
Please Select
1
2
3
4
5
NA
Comments
Study Lounge: Walls
Please Select
1
2
3
4
5
NA
Comments
Study Lounge: Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Study Lounge)
Please Select
1
2
3
4
5
NA
Overall Comments (Study Lounge)
Elevator:
Take Photo
Elevator Number
Elevator: Floor
Please Select
1
2
3
4
5
NA
Comments
Elevator: Furniture
Please Select
1
2
3
4
5
NA
Comments
Elevator: Vents
Please Select
1
2
3
4
5
NA
Comments
Elevator: Walls
Please Select
1
2
3
4
5
NA
Comments
Elevator: Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Elevator: Tracks
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Elevator)
Please Select
1
2
3
4
5
NA
Overall Comments (Elevator)
Trash Rooms:
Take Photo
Trash Room: Floor #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Trash Room: Floor
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Furniture
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Vent
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Walls
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Trash/Recycling Signs
Please Select
1
2
3
4
5
NA
Comments
Trash Room: Bags Stocked
Please Select
1
2
3
4
5
NA
Comments
Overall Level (Trash Room)
Please Select
1
2
3
4
5
NA
Overall Comments
Stairwells:
Take Photo
Stairwell: Location
Stairwell: Dry Mopped
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Wet Mopped
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Light Fixtures
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Handrails
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Spindles
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Window Ledges
Please Select
1
2
3
4
5
NA
Comments
Stairwell: Push Plates
Please Select
1
2
3
4
5
NA
Comments
Overall Comments (Stairwell)
Overall Level (1-5) (Stairwell)
Please Select
1
2
3
4
5
NA
Overall KPI Schedule Level (1-5)
Please Select
1
2
3
4
5
NA
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