Back of House Cleaning Report Form
Please complete this Back of House Cleaning Report Form to document your cleaning inspection. Ensure all items are accurately recorded.
Staff Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Inspection
*
Hour Minutes
AM
PM
AM/PM Option
Area Inspected
*
Please Select
Kitchen
Storage Room
Dishwashing Area
Staff Restroom
Loading Dock
Other
Floors cleaned and free of debris
*
Completed
Not Applicable
Surfaces sanitized (tables, counters, etc.)
*
Completed
Not Applicable
Trash removed and bins replaced
*
Completed
Not Applicable
Equipment wiped down and checked
*
Completed
Not Applicable
Supplies restocked (soap, paper towels, etc.)
*
Completed
Not Applicable
Additional Comments or Issues Noted
Submit Report
Should be Empty: