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ISSA CLEAN STANDARD: MEASURING THE EFFECTIVENESS OF CLEANING ISSA® — The Worldwide Cleaning Industry Association • 3300 Dundee Road, Northbrook, IL 60062 USA 800-225-4772 (North America) or 847-982-0800 • issa.com Building: __________________________________________________________________________________ Date: ___________________________________________________ Page __________of __________ Pages Okay = 1 Needs Some Attention = 2 Needs Immediate Attention = 3 Area Name/ # ______ Area Name/ # ______ Area Name/ # ______ Area Name/ # ______ Area Name/ # ______ Survey Item - add as needed Notes on Area/# : ____________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Notes on Area/# : ____________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Notes on Area/# : ____________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Notes on Area/# : ____________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Notes on Area/# : ____________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Section O6: Other Area 6: __________________________

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