Access Control and Surveillance Assessment Checklist Form
Use this form to assess access control and surveillance readiness at a site. Complete the checklist items, ratings, and notes so security gaps and follow-up actions can be identified.
Site and Respondent Details
Assessment Location / Site Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Respondent Name
*
Respondent Role / Title
*
Contact Email
*
example@example.com
Access Control Assessment
Access Control Readiness Checklist
*
Rows
Yes
No
N/A
Door locks are in place and functioning
1
2
3
Badge/access cards are issued and controlled
4
5
6
Visitor management procedures are in place
7
8
9
Keys are tracked and issued under control
10
11
12
Access logs are reviewed regularly
13
14
15
Overall access control effectiveness
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Notes on deficiencies or corrective actions
Surveillance Assessment
Surveillance System Coverage and Monitoring
*
Rows
Not in Place
Partial
Adequate
Strong
Excellent
Camera coverage of entrances and exits
16
17
18
19
20
Camera coverage of perimeter and critical areas
21
22
23
24
25
Recording retention meets facility requirements
26
27
28
29
30
Monitoring displays are visible to authorized staff
31
32
33
34
35
Cameras and recording equipment are functioning properly
36
37
38
39
40
Incident review and playback capability is available
41
42
43
44
45
Notes on surveillance gaps or issues found
Submit Assessment
Should be Empty: