Facility Monitoring and Control System Checklist Form
Complete this checklist to document facility system monitoring, operational status, and any required actions.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Full Name
*
First Name
Last Name
Current Facility Operational Status
*
Fully Operational
Partially Operational
Non-Operational
Environmental Conditions
*
Temperature Normal
Humidity Normal
Air Quality Acceptable
Lighting Adequate
Noise Level Acceptable
Critical Equipment Status
*
Rows
Operational
Requires Attention
Not Applicable
Power Supply
1
2
3
HVAC System
4
5
6
Security System
7
8
9
Fire Safety Equipment
10
11
12
Any Active Alarms or Faults?
*
No Alarms or Faults
Yes, Alarms Present
Yes, Faults Detected
Maintenance or Service Required?
*
No Maintenance Needed
Preventive Maintenance Due
Corrective Maintenance Required
Issues or Irregularities Observed
Actions Taken or Follow-Up Required
Additional Comments or Notes
Submit Checklist
Should be Empty: