Title Page
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Conducted on
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Prepared by
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Location
Inspection Resident Room
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Door/Sills
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Lights/Switches/lamps
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Ceiling/walls
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Baseboards
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Waste basket
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Pictures
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TV
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Table/Dressor
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Bed
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Chairs
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Floor
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Window sill/blinds
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Closet
Resident Bathroom
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Soap
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Paper products
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Waste basket
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Light
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Mirror
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Sink
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Toilet
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Shower
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Walls
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Floor
Housekeeping Cart
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Locked
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Stocked
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Clean
