University Dormitory Health Inspection Form
Complete this form to document the results of a university dormitory health and safety inspection.
Inspector Name
*
First Name
Last Name
Inspector Email Address
*
example@example.com
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Dormitory Name or Building
*
Room/Floor Number(s) Inspected
*
Inspection Criteria
*
Rows
Excellent
Good
Needs Improvement
Unsatisfactory
Room Cleanliness
1
2
3
4
Bathroom/Toilet Hygiene
5
6
7
8
Waste Disposal & Trash Bins
9
10
11
12
Pest Control & Evidence of Infestation
13
14
15
16
Ventilation & Air Quality
17
18
19
20
Safety Equipment (fire extinguisher, smoke detector)
21
22
23
24
Laundry Facilities Cleanliness
25
26
27
28
Common Area Cleanliness
29
30
31
32
Food Storage/Preparation Area
33
34
35
36
Are there any urgent health or safety hazards present?
*
No hazards observed
Yes, urgent hazards found (describe below)
Comments and Recommendations
Upload Photos (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Inspector Signature
*
Submit Inspection
Submit Inspection
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