Smoking Area Inspection Checklist Form
Use this form to record a smoking area inspection, note compliance conditions, and track any corrective actions needed.
Inspection Details
Inspection date
*
-
Month
-
Day
Year
Date
Inspection time
*
Hour Minutes
AM
PM
AM/PM Option
Inspector name
*
Site/location name
*
Smoking area location or identifier
*
Inspection type/status
*
Routine
Follow-up
Complaint-based
Pre-opening
Smoking Area Condition and Compliance
Inspection Findings
*
Signage present and visible
Ashtrays/receptacles available
Cigarette butt disposal condition acceptable
Area clean and free of litter
Odor/smoke contained within designated area
Non-smoking boundary respected
No fire safety hazards observed
Overall Compliance Status
*
Please Select
Compliant
Partially Compliant
Non-Compliant
Not Applicable
Deficiencies Observed / Notes
Corrective Action and Follow-up
Corrective Action Needed
*
Responsible Party / Department
*
Follow-up Required
*
Please Select
Yes
No
Pending
Target Completion Date
-
Month
-
Day
Year
Date
Follow-up Notes
Submit
Should be Empty: