Bed Bug Inspection

• Inspected by

• Bedroom

• Conducted on

  Date

• Conducted by

• Inspection type

  Routine

  Complaint Response

• Check for bed bugs, eggs and/or signs of bed bugs in the following areas

• Bed (including the mattress and its seams, bed sheets, and box spring)

  Clear

  Contaminated

• Bed frame

  Clear

  Contaminated

• Pillows (including the inside of sheets)

  Clear

  Contaminated

• Head board

  Clear

  Contaminated

• Foot board

  Clear

  Contaminated

• Night stand

  Clear

  Contaminated

• Lamp shade

  Clear

  Contaminated

• Carpets

  Clear

  Contaminated

• Other areas/items where bed bugs and/or signs of bed bugs are present?

Sign off

• Full name and signature of inspector