Retail Store Restroom Inspection Form
Store Name
Inspector
Date
Time
Restroom Area
Floors clean and dry
Yes
No
N/A
Trash emptied
Yes
No
N/A
Sink and counters clean
Yes
No
N/A
Mirrors clean
Yes
No
N/A
Toilets/urinals clean
Yes
No
N/A
Soap available
Yes
No
N/A
Paper towels/toilet paper stocked
Yes
No
N/A
No foul odors
Yes
No
N/A
Comments/Notes
Inspector Signature