Form Pdf — Housekeeping Evaluation

Date: _______________ Evaluator Name: _______________ Area / Room Number: _______________ Shift: ☐ Morning ☐ Afternoon ☐ Night 1. Cleaning Quality | Criteria | Excellent (4) | Good (3) | Fair (2) | Poor (1) | N/A | |----------|--------------|----------|----------|----------|-----| | Floors swept / mopped / vacuumed | ☐ | ☐ | ☐ | ☐ | ☐ | | Surfaces dusted & sanitized | ☐ | ☐ | ☐ | ☐ | ☐ | | Trash emptied & liners replaced | ☐ | ☐ | ☐ | ☐ | ☐ | | Glass / mirrors streak-free | ☐ | ☐ | ☐ | ☐ | ☐ | | Restroom fixtures & floors clean | ☐ | ☐ | ☐ | ☐ | ☐ | | Odor control (fresh, no bad smells) | ☐ | ☐ | ☐ | ☐ | ☐ | | High touchpoints disinfected | ☐ | ☐ | ☐ | ☐ | ☐ |

4. Overall Rating (circle one) Poor Fair Good Excellent 5. Action Required (if applicable) ☐ No action needed ☐ Verbal coaching ☐ Retraining needed (by: _______________) ☐ Write-up / formal improvement plan housekeeping evaluation form pdf

3. Safety & Compliance | Criteria | Yes | No | N/A | |----------|-----|-----|-----| | Wet floor signs used when needed | ☐ | ☐ | ☐ | | No slip/trip hazards | ☐ | ☐ | ☐ | | Cleaning chemicals properly labeled & stored | ☐ | ☐ | ☐ | | PPE worn appropriately | ☐ | ☐ | ☐ | Action Required (if applicable) ☐ No action needed