GBM Quality Assurance Inspection Form
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Minutes
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PM
AM/PM Option
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address2
*
Able to Enter
*
Yes
No - building closed
No - building open but no one comes to the door
No - building open but denied access
Details of Unable to Enter (if applicable)
Facility Manager
Amy Tedford
Randy Bruno
Joe Dudley
Lori Long
Wes Cannon
Thomas Ward
TJ Wood
Cory Crabtree
Testing
Subcontractor
Absolute
AKC
Commercial
Global
Jowers
Prime
Walker
Self Perform
Day Cleaning Frequency
0
1
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5
Night Cleaning Frequency
0
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Inspected By
*
Blake Lovan
Dakotah Highfil
Demetria Leach
Don Champion
Jennifer Headen
Test
Escorted By
First Name
Last Name
Type of Escort
*
JLL
Agency
Self-guided
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Supplies
Equipment on Hand
*
Rows
QTY
Condition
What needs repair?
How many to order?
Vacuums
Good
Needs Repair
Needs New
Backpack Vacuums
Good
Needs Repair
Needs New
Mop Buckets
Good
Needs Repair
Needs New
Mops
Good
Needs Repair
Needs New
Brooms
Good
Needs Repair
Needs New
Janitor Carts
Good
Needs Repair
Needs New
Supply
*
Rows
1
2
3
4
5
Supplies are stored in an organized manner.
Building has enough consumables for the rest of the month.
Building has enough cleaning chemicals for the rest of the month.
Building has enough equipment for the rest of the month.
Equipment is in good working condition.
Dispensers are in good working condition.
Dispensers to Order
Rows
Type
QTY
1.
Tissue
Towels
Soap
Sanitary Bag
Toilet Seat Cover
2.
Tissue
Towels
Soap
Sanitary Bag
Toilet Seat Cover
3.
Tissue
Towels
Soap
Sanitary Bag
Toilet Seat Cover
4.
Tissue
Towels
Soap
Sanitary Bag
Toilet Seat Cover
5.
Tissue
Towels
Soap
Sanitary Bag
Toilet Seat Cover
Supply Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Supply Images
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Supply Photo
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Total Supply Score
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Service Quality
1 - Very Dissatisfied, 2 - Dissatisfied, 3 - Neutral, 4 - Satisfied, 5 - Very Satisfied
Janitor Closet
Rows
1
2
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Floor is free of debris and stains.
Sink/tub/basin is clean, drain works, and odor-free.
Horizontal surfaces are clean and organized.
Janitor Closet Images
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Janitor Closet Photo
Janitor Closet Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Janitor Closet Score
Entrances/Lobbies (Leave blank if not applicable)
Rows
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5
Walls are free of stains.
Floors are free of debris and stains.
Edges/Baseboards are free of dust and stains.
Doorway thresholds/mats are clean.
Glass is clean and smudge-free.
Furniture is clean and dust-free.
Drinking fountains are clean.
Horizontal surfaces are clean and dust-free.
Entrance/Lobbies Score
Entrances/Lobbies Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Entrance/Lobbies Images
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Entrance/Lobbies Photo
Stairs/Elevators (Leave blank if not applicable)
Rows
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Stairs steps/Landings are free of debris and stains.
Stairs handrails are clean and dust-free.
Edges/Baseboards are free of of dust and stains.
Walls are free of stains.
Corners are free of cobwebs and debris.
Elevator doors are clean and smudge-free.
Elevator button panels are clean and smudge-free.
Floors are free of debris and stains.
Stairs/Elevators Score
Stairs/Elevators Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Stairs/Elevators Images
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Stairs/Elevators Photo
Restrooms (Leave blank if not applicable)
Rows
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2
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5
Floors are free of debris and stains.
Edges/Baseboards are free of dust and stains.
Walls and or Stall partitions are free of stains, dust and smudges.
Mirrors and counter tops are free of stains and smudges.
Faucets are free of stains and smudges.
Sinks are free of stains.
Toilets/urinals are free of stains inside and out and odor-less.
Dispensers are free of dust and stains/stocked/functional. (State in the Notes section of specific dispensers that are out of batteries or broken)
Restrooms Score
Restrooms Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Restrooms Images
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Restrooms Photo
Workspaces
*
Rows
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5
Walls are free of stains.
Floors are free of debris and stains.
Edges/Baseboards are free of dust and stains.
Horizontal surfaces are clean and dust-free. (i.e light switches)
Trash containers are clean and not overflowing.
Drinking fountains are clean.
Doors at entrances and work area cubical tops are free of dust.
Workspaces Score
Workspaces Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Workspaces Images
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Workspaces Photo
Conference Rooms (leave blank if not applicable)
Rows
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Walls are free of stains.
Floors are are free of debris and stains.
Edges/Baseboards are free of dust and stains.
Furniture is clean and dust-free.
Horizontal surfaces are clean and dust-free
Table tops are clean.
Trash containers are clean and not overflowing.
Conference Rooms Score
Conference Rooms Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Conference Rooms Images
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Conference Rooms Photo
Break Rooms (Leave blank if not applicable)
Rows
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Walls are free of stains.
Floors are free of debris and stains.
Edges/Baseboards are free of dust and stains.
Horizontal surfaces are clean and dust-free. (i.e light switches, dispensers, or phones)
Table tops are clean.
Countertops are clean.
Sinks are free of stains.
Dispensers are free of dust and stains/stocked/functional. (State in the Notes section of specific dispensers that are out of batteries or broken)
Trash containers are clean and not overflowing.
Refrigerators/Microwaves front exteriors are free of stains and dust.
Break Room Score
Break Room Notes
Explanation must be provided for each criteria that scores a 3 or below in this category.
Break Room Images
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Break Room Photo
Total Service Quality Score
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Customer Feedback
Name
First Name
Last Name
Feedback
Confirmation
Completion Time
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Minutes
AM
PM
AM/PM Option
By selecting, you have confirmed that all identifying facility information has been provided on page 1
*
Confirm
Type a question
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness
Time Sheet hours confirmed
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