Contamination Inspection Checklist Form
Complete this Contamination Inspection Checklist Form to document all required details during your contamination inspection.
Inspector Name
*
First Name
Last Name
Inspection Date
*
-
Month
-
Day
Year
Date
Inspection Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Inspection Location
*
Type of Contamination Observed
*
Biological
Chemical
Physical
Other
Area Cleanliness
*
Acceptable
Needs Attention
Unacceptable
Containment Measures in Place
*
Yes
No
Not Applicable
Personal Protective Equipment (PPE) Used
*
Gloves
Mask/Respirator
Gown/Lab Coat
Eye Protection
Other
Severity of Contamination
*
1
2
3
4
5
Corrective Actions Required
*
Additional Comments or Observations
Submit Inspection
Should be Empty: