Public Restroom Cleanliness Monitoring Log
Use this log to record the cleanliness, condition, and maintenance needs of public restrooms during routine inspections.
Restroom Location
*
Date and Time of Inspection
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
Overall Cleanliness Rating
*
1
2
3
4
5
Are toilet paper supplies adequate?
*
Adequate
Low
Empty
Are soap dispensers stocked?
*
Stocked
Low
Empty
Are paper towels or hand dryers available?
*
Available
Low/Partial
Unavailable
Condition of Toilets/Urinals
*
Clean and Working
Dirty
Needs Repair
Are sinks and faucets clean and operational?
*
Clean and Working
Dirty
Needs Repair
Odor Status
*
No Odor
Mild Odor
Strong Odor
Is there visible litter or debris?
*
None
Some
Excessive
Is there graffiti or vandalism present?
*
None
Minor
Significant
Maintenance Issues Observed (select all that apply)
Leaking fixtures
Broken doors/locks
Lighting problems
Clogged drains
Other
Actions Taken or Reported
Restocked supplies
Cleaned surfaces
Reported maintenance
No action needed
Other
Additional Comments or Notes
Submit Log
Should be Empty: