Medical Exam Room Inspection Checklist
Complete this checklist to ensure exam room readiness, cleanliness, and compliance with standards.
Inspector Full Name
*
First Name
Last Name
Date and Time of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Exam Room Number or Name
*
Overall Room Cleanliness
*
Excellent
Good
Fair
Poor
Exam Room Inspection Items
*
Rows
Pass
Fail
N/A
Exam table sanitized
1
2
3
Countertops/disinfected
4
5
6
Sink and faucet clean
7
8
9
Sharps container present
10
11
12
Hand sanitizer available
13
14
15
Personal protective equipment stocked
16
17
18
Biohazard waste bin present
19
20
21
Medical instruments present and functional
22
23
24
Are all required medical supplies stocked?
*
Yes, fully stocked
Partially stocked
Not stocked
Rate the overall safety compliance of the room
*
1
2
3
4
5
Is emergency equipment (e.g., oxygen, defibrillator) present and functional?
*
Yes
No
Not applicable
Comments or Notes
Submit Inspection
Should be Empty: