Title Page

  • Inspected by

  • Room Number/Room Name

  • Conducted on

  • Inspection type

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

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

  • Bed frame

  • Pillows (including the inside of sheets)

  • Head board

  • Foot board

  • Night stand

  • Lamp shade

  • Walls

  • Wall hangings (pictures, posters, paintings)

  • Sofa

  • Upholstered chairs

  • Carpets

  • Outlets

  • Dresser

  • Closets

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

Sign off

  • Full name and signature of inspector

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