Facility Cleaning Quality Survey
Please provide your feedback on the cleanliness and maintenance of our facility to help us improve our services.
Your Name or Role
Facility/Area Assessed
*
Please Select
Lobby/Reception
Restrooms
Offices
Meeting Rooms
Hallways/Common Areas
Cafeteria
Other
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Cleanliness
*
1
2
3
4
5
Please rate the following aspects of cleaning quality:
*
Rows
Excellent
Good
Fair
Poor
Restroom Cleanliness
1
2
3
4
Trash Removal
5
6
7
8
Floor Condition
9
10
11
12
Surface Disinfection
13
14
15
16
Supply Stocking
17
18
19
20
Were any areas missed or needing attention?
Restrooms
Trash Cans
Floors
Surfaces (Desks, Tables, etc.)
No, all areas were cleaned
Other
Additional Comments or Suggestions
Submit Survey
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