Building

01 Absence of overcrowding

02 Structural Integrity

03 Condition of floors

04 Condition of walls & windows

05 Condition of ceilings

06 Lighting adequacy

07 Ventilation adequacy

Water Supply

08 Potability

Chlorine residual reading

Chlorine residual reading

09 Condition of plumbing system (taps, pipes etc.)

10 Water adequacy/availability

Excreta Disposal

11 Condition of water closets

12 Condition of sewer system

13 Condition of handwashing stations

14 Condition of shower areas

Food Handling Facilities

15 Food storage areas

16 Condition of utensils, equipment, structural facilities etc.

17 Condition of dining areas

18 Food handling practices

19 Condition of cold storage units

Temperature logs (Food storage)
Unit 1 (chiller)
Unit 1 (freezer)
Unit 2 (chiller)
Unit 2 (freezer)

20 Condition of cold storage units for non-food items

temperature logs (Non-food storage)
Unit 3 (chiller)
Unit 3 (freezer)
Unit 4 (chiller)
Unit 4 (freezer)

Solid Waste Management

21 Waste segregation measures appropriate

22 Condition of waste bins

23 Use & storage of sharps boxes

Safety Measures

24 Fire extinguisher storage and maintenance

25 Presence of trip/slip/fall hazards

26 Presence of obstructions (e.g in walkways etc.)

27 Presence of ergonomic hazards

28 Presence of chemical hazards

29 Presence of biological hazards

30 Condition of emergency exits

31 Infection control practices

Pests

32 Evidence of infestation

Treatment/ baits set

Patient Areas

33 Condition of beds, machines, monitors etc

34 Handwashing stations adequate (amount, functioning & equipped)

35 Cleaning schedule present

36 Housekeeping staff observed while working

Cleaning chemicals mixed/prepared appropriately

Cleaning technique used appropriately based on the item being cleaned

Appropriate PPE worn, donned and doffed according to approved standards

Hand hygiene performed correctly

Comments

Important concerns

Inspector's signature
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.