Worksite Cleanliness Certification Form
Please complete this form to certify that the worksite meets cleanliness standards. All responses will be reviewed for compliance.
Worksite Name
*
Worksite Location
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector's Full Name
*
First Name
Last Name
Cleanliness Standards Met
*
Floors and walkways are clean and free of debris
Waste bins are emptied and properly maintained
Restrooms are cleaned and stocked
Common areas are tidy and organized
Hazardous materials are stored safely
Other
Additional Notes (if any)
Upload Supporting Photos (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Inspector's Signature
*
Submit Certification
Submit Certification
Should be Empty: