Healthcare Regulatory Inspection Checklist
Use this form to document a healthcare facility inspection, record compliance checks, note findings, and track corrective actions.
Inspection Details
Inspection Date
*
 -
Month
 -
Day
Year
Date
Inspection Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Facility Name
*
Facility Type
*
Please Select
Hospital
Clinic
Ambulatory Surgery Center
Nursing Home
Laboratory
Pharmacy
Other
Facility Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Inspector Name or Inspection Team
*
Inspection Type or Purpose
*
Please Select
Routine
Follow-up
Complaint-driven
Pre-licensure
Internal Audit
Other
Additional Inspection Details
Compliance Checklist
Infection Control Compliance
*
Rows
Yes
No
Partially Compliant
Not Applicable
Hand hygiene practices
1
2
3
4
PPE availability and use
5
6
7
8
Isolation procedures
9
10
11
12
Surface disinfection
13
14
15
16
Medication Storage and Labeling
*
Rows
Pass
Fail
Needs Review
Not Applicable
Storage conditions within acceptable range
17
18
19
20
Labels are clear and current
21
22
23
24
Segregation of expired items
25
26
27
28
Controlled access to medication areas
29
30
31
32
Patient Privacy and Records Handling
*
Rows
Yes
No
Partially Compliant
Not Applicable
Confidential records are secured
33
34
35
36
Privacy maintained during care delivery
37
38
39
40
Records access is role-based
41
42
43
44
Information disposal practices are secure
45
46
47
48
Equipment Maintenance and Calibration
*
Rows
Pass
Fail
Needs Review
Not Applicable
Preventive maintenance logs available
49
50
51
52
Calibration records current
53
54
55
56
Out-of-service equipment clearly marked
57
58
59
60
Defective equipment removed from use
61
62
63
64
Emergency Preparedness
*
Rows
Yes
No
Partially Compliant
Not Applicable
Emergency exits accessible
65
66
67
68
Evacuation plan posted
69
70
71
72
Emergency supplies available
73
74
75
76
Staff know emergency response procedures
77
78
79
80
Waste Disposal and Sharps Handling
*
Rows
Pass
Fail
Needs Review
Not Applicable
Biohazard waste segregation
81
82
83
84
Sharps containers properly used
85
86
87
88
Containers not overfilled
89
90
91
92
Waste storage area secure
93
94
95
96
Cleanliness and Sanitation
*
Rows
Yes
No
Partially Compliant
Not Applicable
Patient areas clean and orderly
97
98
99
100
Restrooms sanitized
101
102
103
104
Cleaning schedules followed
105
106
107
108
Approved disinfectants in use
109
110
111
112
Staff Training and Credential Verification
*
Rows
Pass
Fail
Needs Review
Not Applicable
Required training completed
113
114
115
116
Credentials verified and current
117
118
119
120
Orientation records available
121
122
123
124
Competency assessments documented
125
126
127
128
Accessibility and Safety
*
Rows
Yes
No
Partially Compliant
Not Applicable
Accessible entrances and routes
129
130
131
132
Handrails and floor safety
133
134
135
136
Clear signage and wayfinding
137
138
139
140
Hazards promptly addressed
141
142
143
144
Incident Reporting
*
Rows
Pass
Fail
Needs Review
Not Applicable
Incidents are documented
145
146
147
148
Reporting timeline is followed
149
150
151
152
Follow-up actions recorded
153
154
155
156
Staff understand reporting procedure
157
158
159
160
Findings and Corrective Actions
Overall Inspection Result
*
Compliant
Minor Issues
Major Issues
Non-Compliant
Priority / Severity
*
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
Specific Deficiencies Found
Corrective Actions Required
Responsible Department or Contact Role
Target Completion Date
 -
Month
 -
Day
Year
Date
Follow-up Required
*
Yes
No
Inspector Summary
Inspector Summary / Comments
Final Recommendation / Disposition
*
Approved
Approved with Conditions
Reinspection Required
Enforcement Review Needed
Inspector Name and Confirmation
*
First Name
Last Name
Submit Inspection
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