Agency Inspection Checklist
Complete this Agency Inspection Checklist Form to document inspection details, site conditions, and any required follow-up for agency locations.
Agency/Site Identifier
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Department/Area Inspected
*
Overall Condition Rating
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Cleanliness, Safety, and Compliance Checklist
*
Floors and surfaces are clean
Fire exits are accessible
Signage and labels are visible
No visible hazards present
PPE is available and in use
Other
Equipment/Asset Status
*
Please Select
All functional
Some require maintenance
Major issues
Not applicable
Issues Observed
Corrective Actions or Follow-up Tasks
Final Remarks or Approval Status
*
Approved
Approved with conditions
Not approved
Other
Submit Inspection
Should be Empty: