• Worker Dormitory Compliance Assessment Form

    Use this form to inspect a worker dormitory, record compliance findings, and document any corrective actions needed.

  • Dormitory Identification

  • Inspection Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Occupancy and General Conditions

  • Room-by-Room Occupancy vs Capacity*
  • Overall Condition*

  • Living Environment and Sanitation

  •
  • Observed sanitation issues

  • Safety and Fire Preparedness

  • Fire extinguishers available and accessible*
  • Emergency exits clear*
  • Exit signage visible*
  • Smoke alarm status*
  • Emergency evacuation plan posted*
  • Hazards observed

  • Maintenance Findings and Corrective Action

  • Severity of Issues*
  • Target Completion Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty:
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