Exam Chair Quality Inspection Checklist Form
Use this form to inspect exam chairs in testing rooms, record their condition, note any issues, and document the final inspection outcome.
Inspection Details
Inspection Date
*
-
Month
-
Day
Year
Date
Inspector Name
*
Inspection ID / Reference Number
*
Exam Room / Location
*
Chair Identifier / Tag Number
*
Chair Condition Checklist
Chair Stability
*
Rows
Pass
Fail
Chair stability
1
2
Seat Condition
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Backrest Condition
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Armrest Condition (if present)
Compliant
Non-compliant
Not present
Leg/Base Condition
*
Good
Fair
Poor
Upholstery / Surface Condition
*
Good
Fair
Poor
Cleanliness
*
Clean
Needs cleaning
Dirty
Overall Structural Integrity
*
Compliant
Non-compliant
Issues and Corrective Action
Defects or issues found
*
Severity level
*
Minor
Moderate
Critical
Immediate action taken
Repair or replacement needed
*
Yes
No
Inspector final outcome
*
Pass
Pass with notes
Fail
Submit Inspection
Should be Empty: