Name

Email

Date of Inspection

Facility Address

Inspection Purpose

• Routine

• Compliance

• Follow-up

Is the facility clean and well-maintained?

Are floors, walls, and ceilings free of damage?

Are emergency exits accessible and clearly marked?

Are fire extinguishers, alarms, and safety equipment functional?

Are electrical, HVAC, and plumbing systems in good working order?

Are there any visible signs of leaks, outages, or malfunctions?

Is the facility compliant with accessibility standards (e.g., ramps, elevators)?

Are restrooms and common areas accessible and functional?

Immediate Repairs Required

Overall Facility Condition

Supporting Documents

Attach any relevant PDF, image, etc.

Recommendations or Actions Required:

Provide any recommendations or actions required based on the inspection findings.