Title Page

  • Conducted on

  • Prepared by

  • Location
  • When is this inspection being conducted?

  • Location:

  • All rooms should be clean. Electrical wires should be secure, vents functional, and light switch and outlet face-plates present and undamaged. Evacuation plans should be present in every room. Water and electricity must be functional. All room numbers of rooms with discrepancies and those discrepancies should be recorded.

General Housekeeping

  • Are the main rooms clean?

  • Are the bathrooms clean?

  • Does the water work?

  • Are vent fans and lights present and functional?

  • Are the walls in good condition?

  • Is the carpet/tile in good condition?

  • Is the ceiling in good condition?

  • Are windows in good condition?

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  • Notes:

Electrical Safety

  • Are light switch covers and outlet covers present and undamaged?

  • Are electrical cords in good condition?

  • Is there any exposed or unsecured wiring?

  • Are there any electrical appliances or additions that should not be present?

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  • Notes:

Emergency Items

  • Are evacuation plans present?

  • Are fire extinguishers present and well-maintained?

  • Are emergency lighting and exit signs functional?

  • Is there a well-maintained first aid kit in the section?

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  • Notes:

  • Center Safety Officer:

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