Open hungple opened 6 years ago
Name of Inspector: Building: Room or Area: Inspect Date:
Is clean and neat? (yes/no/na): No Assessment/Observation/Comment:
Any damage or brokenness? (yes/no/na): Everything is old and dirty Assessment/Observation/Comment:
Electrical, Mechanical, Ergonomic (yes/no/na): Assessment/Observation/Comment:
Information
Name of Inspector:
Building:
Room or Area:
Inspect Date:
Cleanliness & Neatness
Is clean and neat? (yes/no/na): No Assessment/Observation/Comment:
Physical Structure
Any damage or brokenness? (yes/no/na): Everything is old and dirty Assessment/Observation/Comment:
Safety Concerns
Electrical, Mechanical, Ergonomic (yes/no/na): Assessment/Observation/Comment: