Quality Inspection Report (IQIR)
SECTION 1- VISIT DETAILS
Date of Service
-
Month
-
Day
Year
Date
Inspector Name
Please Select
Jermaine Whiteside
Simone Whiteside
James Polivka
Staff On Duty
Please Select
Jermaine Whiteside
Simone Whiteside
Simone Black
April Whiteside
Kayla Whiteside
James Polivka
Shift Time In
Hour Minutes
AM
PM
AM/PM Option
Shift Time Out
Hour Minutes
AM
PM
AM/PM Option
SECTION 2 - CLEANING AREA QUALITY SCORES
A- OFFICES
0
1-2
3-4
5
Trash Removed
Desks checked (only if in scope)
Floors swept/vacuumed
Visible clutter reported properly
B-RESTROOMS
0
1-2
3-4
5
Toilets cleaned
Supplies restocked
Floors mopped
Mirrors and counters cleaned
C- COMMON AREAS
0
1-2
3-4
5
Hallways free of debris
Trash emptied
Cardboard reported
Floors cleaned
D- BREAK ROOMS
0
1-2
3-4
5
Trash removed (only per contract scope)
Countertop cleanliness
Spills reported
E- EXTERIOR DOORS/ ENTRY POINTS
0
1-2
3-4
5
Closed/secured
Glass spot-checked
SECTION 3- INTERNAL ISSUES FOUND (SGHG RESPONSIBLITY)
This section isolates only SGHG-caused problems
Checklist
Not Satisfied
Somewhat Satisfied
Comments
Trash not emptied
Liners not replaced
Soap/towels not restocked
Toliet not flushed
Floors missed
Door left open
Entry not secured
Checklist not completed
Time reported incorrectly
Supplies not communicated (low stock)
Other Internal Issues
SECTION 4- CLIENT -CREATED ISSUES (Not SGHG Responsiblity)
Checkbox List
Yes
No
Internal Issue = 5 PtsSeverity Level 2= 10 PtsSeverity Level 3= 20 Pts
Cardboard left beside trash cans
Trash left on breakdown tables
Office clutter blocking cleaning
Food waste left behind
Spills not cleaned by staff
Conference room restricted
Room locked
Private office content not to be moved
Other client-created issues
SECTION 5- INCIDENT SEVERITY LEVEL
To incorporate Six Sigma data:
Rate Level of Severity Level
Please Select
Level 1: Minor (does not interfere with cleaning
Level 2: Moderate (require delay or work-around
Level 3: Major (prevents cleaning or creates liability)
This becomes part of your Six Sigma chart
SECTION 6- INTERNAL QUALITY SCORE
Score Ranges:
Please Select
90-100 = Excellent
80-89=Acceptable
70-79= Needs Improvement
Under 70= Critical -Retraining Required
SECTION 7- SUPERVISOR COMMENTS & FOLLOW UP
NOTES
Follow-up required
Yes
No
Retraining needed
Yes
No
Supply issues noted
Yes
No
Additional photos
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Phone Number
Please enter a valid phone number.
Email
example@example.com
Location of Inspection
Please Select
BESC
Other
Other Selection Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Inspected Date
-
Month
-
Day
Year
Date
Inspectors comments
Submit
Should be Empty: