Blood Bank Facility Inspection Form

Facility Name

Facility Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Inspection Date

Date

Inspector's Full Name

First NameLast Name

Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Facility Cleanliness

Equipment Condition

Blood Storage Conditions

Safety Protocols Compliance

Additional Comments

Inspector Signature