Medical Facility Inspection Checklist Form
Complete this checklist to assess key areas of a medical facility. Please provide clear, objective ratings and comments for a comprehensive inspection.
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Overall Facility Cleanliness
*
1
2
3
4
5
Are all medical equipment clean and in working order?
*
Yes
No
Not Applicable
Are emergency exits clearly marked and accessible?
*
Yes
No
Not Applicable
Staff hygiene and use of personal protective equipment (PPE)
*
1
2
3
4
5
Are all required documentation and records up to date?
*
Yes
No
Not Applicable
Fire safety equipment present and functional
*
Yes
No
Not Applicable
Is patient privacy being maintained throughout the facility?
*
Yes
No
Not Applicable
Additional Comments or Observations
Submit Inspection
Should be Empty: