Housekeeping Inspection Checklist

HOUSEKEEPING INSPECTION CHECKLIST

Facility & Inspection Details

Facility Name:

Location / Area Inspected:

Inspection Date:

Inspector Name:

Position / Title:    Shift:    Supervisor:

Inspection Checklist — General Areas

For each area, mark the appropriate box and provide comments where corrective action is required. "Compliant" indicates the item meets housekeeping standards and safety requirements.

Guest / Patient Rooms

Floors clean and free of debris: Compliant Needs Correction N/A

Surfaces wiped and sanitized: Compliant Needs Correction N/A

Trash removed and liners replaced: Compliant Needs Correction N/A

Corridors & Public Areas

Floors free of slip/trip hazards and debris: Compliant Needs Correction N/A

Exits, egress routes, and signage unobstructed: Compliant Needs Correction N/A

Restrooms

Fixtures clean and sanitized: Compliant Needs Correction N/A

Supplies stocked (soap, paper products, dispensers working): Compliant Needs Correction N/A

Kitchen / Break Room

Food-contact surfaces sanitized and equipment clean: Compliant Needs Correction N/A

Waste containers emptied and stored properly: Compliant Needs Correction N/A

Safety & Chemical Storage

Hazardous chemicals stored and labeled per policy: Compliant Needs Correction

PPE available and used as required: Compliant Needs Correction

Corrective Action Log

Record any items requiring correction, assignment, priority, and due date. Provide verification when correction is completed.

Priority: High Medium Low

Responsible Person:    Due Date:

Personnel Information (Inspector / Employee)

Position Information

Reporting Manager:    Start Date:

Employment History

Provide two most recent employers. Attach additional pages if necessary.

Employer 1 — Dates Employed: to

Employer 2 — Dates Employed: to

Education

Graduation Date:

References (Professional)

Provide three professional references who can verify work performance and reliability.

Legal Disclosures & Authorizations

At-Will Employment: Employment by this organization is at-will, meaning either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice, except as otherwise provided by written agreement signed by an authorized representative.

Equal Opportunity: This organization provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by law. Employment decisions are based on legitimate business needs and individual qualifications.

Authorization to Verify: I authorize the employer and its agents to contact my previous employers and references, and to obtain background checks, verification of credentials, and any other information necessary to evaluate my suitability for employment or assignment. I understand that falsification, omission, or misrepresentation of information may result in denial of employment or disciplinary action including termination.

Applicant Certification: I certify that the information provided in this form and in any attachments is true, complete, and correct to the best of my knowledge. I agree to comply with organizational policies and procedures governing housekeeping operations and safety.

Acknowledgment: I authorize verification and background checks as described above.

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