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Профессиональный Документы
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Name of Supervisor
Company
Name of Public Sanitation Facility
Date of Supervision
Time of Supervision
Name of Operator/Attendant
Business hours
Tariffs
General comment on the appearance and hygienic conditions at the Public Sanitation
Facility (first impression)
Number of Female
Number of Male
Name
Tasks assigned
Working hours:
From
Comments:
To
Do you have any needs to help improving the management of the facility?
Do you have any suggestions on how to improve service provision, customer satisfaction,
revenue collection etc.?
Clean
T2:
Acceptable
Dirty
Comments:
Clean
T3:
Acceptable
Dirty
Comments:
Poster
Existent
Missing
Good
Acceptable
Poor
Comments:
tariff
T3:
Poster
Existent
Recommendations
operator
Missing
Good
Acceptable
Poor
Comments:
for
T4:
Tidy
T5:
Clean
Acceptable
Messy
Dirty
Comments:
Dirty
Comments:
Tidy
T6:
Clean
Acceptable
Messy
T6a
General appearance
Tidy
Clean
Acceptable
Messy
Dirty
Comments:
Clean
Acceptable
Dirty
Flushing
device
working
Toilet
paper
available
Comments:
Water
running
Smelly
Insects
Vandalism
Graffiti
T6b
T6c
Toilet
Clean
Acceptable
Dirty
Paper
towels
available
Soap
available
Tap
leaking
Tap not
functional
Mirror
damaged
Vandalism
Graffiti
Comments:
T7:
T7a
General appearance
Tidy
T7b
Clean
Acceptable
Messy
Dirty
Comments:
Comments:
Toilet cubicles
Clean
Acceptable
Dirty
Flushing
device
working
Toilet
paper
available
Water
running
Smelly
Insects
Vandalism
Graffiti
T7c
Clean
Acceptable
Dirty
Paper
towels
available
Soap
available
Tap
leaking
Tap not
functional
Mirror
damaged
Vandalism
Graffiti
T7d
Comments:
Shower
Clean
Acceptable
Dirty
Tap
leaking
Tap not
functional
Shower
head not
available
Shower
head
damaged
Drainage
blocked
No hooks
for clothing
Lock not
working
Comments:
T8:
T8a
General appearance
Tidy
T8b
Clean
Acceptable
Messy
Dirty
Comments:
Comments:
Toilet cubicles
Clean
Acceptable
Dirty
Flushing
device
working
Toilet
paper
available
Water
running
Smelly
Insects
Vandalism
Graffiti
Acceptable
Dirty
Drainage
blocked
T8c
Urinal
Clean
T8d
Comments:
Clean
Acceptable
Dirty
Paper
towels
available
Soap
available
Tap
leaking
Tap not
functional
Mirror
damaged
Vandalism
Graffiti
T8e
Shower
Clean
Acceptable
Dirty
Tap
leaking
Tap not
functional
Shower
head not
available
Shower
head
damaged
Drainage
blocked
No hooks
for clothing
Lock not
working
Messy
Dirty
T9:
Comments:
Comments:
Tidy
Clean
Acceptable
Comments:
Functional
Non-functional
Problems encountered
Comments:
Water
meter
Water
tanks
Manholes
Sewer
connection
Digester
Door locks
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Worn
out
Needs
replacement
Comments:
Worn
out
Needs
replacement
Comments:
Needs
replacement
Comments:
Not
available
Display book
Available
Not
available
Acceptable
condition
Not
available
Acceptable
condition
Not
available
Acceptable
condition
Worn
out
E2:
Broom
Available
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Not
available
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Acceptable
condition
Worn
out
Needs
replacement
Comments:
Squeegee
Available
Gloves
Available
Cotton cloth
Available
Toilet brush
Available
Lockable cashbox
Available
Not
available
Not available
Comments:
Not available
Comments:
Not available
Comments:
Toilet paper
Available
Paper towels
Available
Not available
Comments:
10