TV Licensing Inspection Visit Report Form

Inspector Full Name

First NameLast Name

Date and Time of Visit

Date

Hour MinutesAM/PM Option

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Occupant Name (if known)

Reason for Visit

Other (specify below)

Inspection Findings

Compliance Status

Actions Taken / Recommendations

Additional Notes

Inspector Signature