Facility Function Evaluation Checklist
Please complete this checklist to evaluate the current functioning and condition of the facility. Your feedback helps us maintain high standards.
Evaluator Name
*
First Name
Last Name
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility Name or Location
*
Overall Cleanliness
*
1
2
3
4
5
Equipment Functionality
*
1
2
3
4
5
Safety and Accessibility
*
1
2
3
4
5
Staff Responsiveness
1
2
3
4
5
Are there any maintenance issues observed?
Yes
No
Additional Comments or Suggestions
Submit Evaluation
Should be Empty: