Clean and dust free

Functioning properly (opening and closing)

Not chipped or cracked

Is the fire evacuation clear and visible


Clean and dust free

Two hangers and one pair of sleepers available

Functioning properly (opening and closing)

Not chipped or cracked

Patient bed

Clean and dust free

Bed is functionally properly to control

Nurse call bell working

Hand rub is awailable at bed side

Clean linen was provided

Attendant couch

Clean and dust free

Upholstery intact


Clean and dust free

Working & fixed properly


Clean and dust free

Pasted properly

Window glass

Clean and smudge free

Window not cracked

Frames fixed properly

Properly filmed

Walls and ceiling

Clean and stain free

No cracks on wall and ceilling

Painted well

Is the smoke detector working appropriately

Is Fire sprinkler is without obstructions


Outlet Grill Clean and dust free

Thermostat working properly


TV remote is working

TV signals are clear


Mirror is stain less

Shower curtain is clean

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.