Facilities Maintenance Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Location

• Center

• Room

Previous Inspection

• Has the last inspection been reviewed?

  Yes

  No

  N/A

• Are there any out standing actions?

  Yes

  No

  N/A

Room

• Carpet Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Tile Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Covebase/Baseboard Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Area Rug Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Heat/Cooling System Condition - Record Temperature

  Okay

  To Hot

  To Cold

  N/A

• Equipment/Furniture Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Lighting

  Okay

  Dirty

  Repair

  Replace

  N/A

• Emergency Lighting Condition (Flashlight)

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Walls

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Ceilings/Vents/Air Return

  Okay

  Dirty

  Repair

  Replace

  N/A

• Conditions of Door

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Fire Extinguisher

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Carbon Monoxide Detector

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Sink - Record Water Temperture

  Okay

  Dirty

  Repair

  Replace

  N/A

• Bubbler/Water Cooler Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Diapering Table - Record Water Temperature

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Windows

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Blinds / Shades

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Storage Units

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Exit Signs

  Okay

  Dirty

  Repair

  Replace

  N/A

• Locked Cabinet

  Okay

  Dirty

  Repair

  Replace

  N/A

• Outlet Cover Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

Bathroom

• Tile Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Covebase/Baseboard Condition

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Walls

  Okay

  Dirty

  Repair

  Replace

  N/A

• Lighting

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Ceilings/Vents/Air Return

  Okay

  Dirty

  Repair

  Replace

  N/A

• Conditions of Door

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Sink - Record Water Temperture

  Okay

  Dirty

  Repair

  Replace

  N/A

• Condition of Toilet/Urinal

  Okay

  Dirty

  Repair

  Replace

  N/A

• Bathroom Daily Check List Updated?

  Yes

  No

  N/A

Sign Off

• Maintenance Tech Signture

  Sign

• Inspector Signature

  Sign