Private Company Facility Evaluation Checklist Form
Please complete this form to evaluate the facility. Your feedback helps us maintain high standards and a safe, comfortable environment.
Evaluator Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Cleanliness
*
1
2
3
4
5
Facility Safety Measures
*
1
2
3
4
5
Condition of Equipment
*
1
2
3
4
5
Accessibility (Entrances, Exits, ADA compliance, etc.)
*
1
2
3
4
5
Staff Professionalism and Helpfulness
*
1
2
3
4
5
Facility Checklist
*
Restrooms are clean and stocked
Emergency exits clearly marked
Fire extinguishers accessible
First aid supplies available
Proper signage throughout facility
Other
Comfort and Ambience
*
1
2
3
4
5
Suggestions for Improvement
Additional Comments
Submit Evaluation
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