Information
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Conducted on
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Prepared by
Self contained room handover checklist
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UNIT
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Room
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Resident name
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Resident present at time of inspection
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Fire door condition
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SPECIFY
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SPECIFY
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Carpet/Vinyl Condition
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SPECIFY
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Chest of Drawers
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SPECIFY
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SPECIFY
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Wardrobe
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SPECIFY
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Condition of bed
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Condition of matress
- Good
- Fair
- Poor
- Damaged by resident
- Missing
- Too long - fire hazard
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Condition of bedside cabinet
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SPECIFY
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SPECIFY
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Lights
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SPECIFY
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Heaters
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SPECIFY
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Condition of Walls
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SPECIFY
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SPECIFY
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Condition of smoke detector
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SPECIFY
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Condition of Windows
- GOOD
- DIRTY
- NEEDS REPAIRS
- DAMAGED BY RESIDENT
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SPECIFY
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Specify
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SPECIFY
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Condition of Blinds / curtains
- Good
- Fair
- Poor
- Damaged by resident
- Missing
- Too long - fire hazard
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Specify
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Rectify
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Management informed?
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MANAGEMENT INFORMED?
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Condition of bathroom Sink
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Specify
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SPECIFY
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Condition of Toilet
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Specify
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SPECIFY
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Condition of shower enclosure
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Condition of mirrored Bathroom cabinet
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Cooker in good working order
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Cooker requires cleaning
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Condition of worktop
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Condition of kitchen sink
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Room cleaning
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Are there electrical items in the room that require PAT Testing?
Resident Signature
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I AM AWARE OF ITEMS ABOVE
