Health Unit Inspection Checklist Form
Complete this checklist to document the inspection of a health unit. Please review each item carefully and provide comments where necessary.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Health Unit Name or Location
*
Overall Cleanliness
*
Excellent
Good
Fair
Poor
Equipment Functionality
*
All operational
Some issues
Major issues
Safety Compliance
*
Fully compliant
Minor issues
Non-compliant
Waste Disposal Practices
*
Properly managed
Needs improvement
Not managed
Hand Hygiene Facilities Available
*
Yes
No
Additional Comments
Inspector Signature
*
Submit Inspection
Submit Inspection
Should be Empty: