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ISSA CLEAN STANDARD: MEASURING THE EFFECTIVENESS OF CLEANING Adapted from: Housekeeping Survey Form – The Ashkin Group School General Checklist – Shaughnessy, et.al., University of Tulsa Indoor Air Quality Program ISSA® — The Worldwide Cleaning Industry Association • 3300 Dundee Road, Northbrook, IL 60062 USA 800-225-4772 (North America) or 847-982-0800 • issa.com A: Roof/Exterior/Neighbors #: __________ Follow-up dates/initials: __________ /__________ G: Restrooms #: __________ Follow-up dates/initials: __________ /__________ M: Maintenance Prog SOPs #: __________ Follow-up dates/initials: __________ /__________ O5: Other 5 #: __________ Follow-up dates/initials: __________ /__________ B: Basements/Crawl Space #: __________ Follow-up dates/initials: __________ /__________ H: Meeting Rooms #: __________ Follow-up dates/initials: __________ /__________ N: Hallways/Commons #: __________ Follow-up dates/initials: __________ /__________ O6: Other 6 #: __________ Follow-up dates/initials: __________ /__________ C: Garage/Docks/Shops #: __________ Follow-up dates/initials: __________ /__________ I: Locker Rooms/Showers #: __________ Follow-up dates/initials: __________ /__________ O1: Other 1 #: __________ Follow-up dates/initials: __________ /__________ O7: Other 7 #: __________ Follow-up dates/initials: __________ /__________ D: Entrances/Lobbies #: __________ Follow-up dates/initials: __________ /__________ J: Food Prep/Dining #: __________ Follow-up dates/initials: __________ /__________ O2: Other 2 #: __________ Follow-up dates/initials: __________ /__________ E: Stairwells/Elevators #: __________ Follow-up dates/initials: __________ /__________ K: Custodial/Storage #: __________ Follow-up dates/initials: __________ /__________ O3: Other 3 #: __________ Follow-up dates/initials: __________ /__________ F: Offices #: __________ Follow-up dates/initials: __________ /__________ L: Mechanical Rooms #: __________ Follow-up dates/initials: __________ /__________ O4: Other 4 #: __________ Follow-up dates/initials: __________ /__________ TOTAL NUMBER OF AREAS NEEDING IMMEDIATE ATTENTION: Appendix A: Building Audit - Long Form Building Name & Location: ___________________________________________________________________ Investigators: Primary: _______________________________________________________________________ Others Involved: _________________________________________________________________ Date: _______________________ Size of Building: ___________________ sq. ft. Number of Floors: _______ Visitors: __________________ Number of Areas Needing Immediate Attention Other Notes: _______________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

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