QUARTERLY FM OFFICE INSPECTION

EXTERIOR INSPECTION

• Pass
• Flag
• Fail

(Exterior notes)

LOBBY, RR 1 & RR 2

• LOBBY CLEAN, NEAT AND SMELLS GOOD

• ALL SIGNAGE, EMERGENCY EQUIPMENT & LICENSES IN PLACE

• RR 1, CLEAN, NEAT, SMELLS GOOD

• RR 1 VENT CLEAN, BATHROOM STOCKED

• RR 1, TOILET FLUSHES AS IT SHOULD, SINK WORKS & DRAINS

• RR 1, LIGHTS ALL WORK, DOOR WORKS & LOCKS

• RR 2, CLEAN NEAT, SMELLS GOOD

• RR 2, VENT CLEAN, STOCKED

• RR 2, TOILET FLUSHES AS IT SHOULD, SINK WORKS & DRAINS

• RR 2 LIGHTS ALL WORK, DOOR WORKS & LOCKS

• WALLS, FLOORS, TRIM, CEILING & PAINT ALL GOOD

• DOORS, DRAWERS & HANDLES OPERATING AS THEY SHOULD BE

(Lobby & Restroom Notes)

OFFICES & CLINICAL

• OFFICES ALL IN GOOD SHAPE / FURNITURE

• SIGNAGE LOOKS GOOD

• ALL LIGHTS WORK

• SINKS OPERATE AS THEY SHOULD

• WALLS, FLOORS, TRIM, PAINT ALL GOOD

• ALL DENTAL CHAIRS OPERATE AS THEY SHOULD

• HOSES NOT KINKED / TRAY TABLES AND LIGHTS ALL WORK

• DOORS, DRAWERS & HANDLES WORKING AS THEY SHOULD

(Offices & Clinical Area Notes)

LABS / BREAKROOM & OTHER AREAS

• ALL EQUIPMENT IN WORKING CONDITION

• ALL EQUIPMENT MAINTENANCE LOGS IN ORDER

• IS THE EQUIPMENT BEING MAINTAINED

• DOOR / DRAWERS AND HANDLES SECURE & WORKING

• ALL LIGHTS WORKING AS THEY SHOULD

• FLOORS, WALLS, TRIM, CEILING ALL GOOD

(Labs, Breakroom & All Other Area Notes)

MISC

• MEDICAL KIT / AED / LOGBOOK UP TO DATE

• FIRE EXTINGUISHER INSPECTIONS CURRENT

• YEARLY FIRE ALARM INSPECTION DONE

• SECURITY ALARMS & CAMERAS ALL WORKING

• SANITATION REQUIREMENTS UP TO DATE

• HALLWAYS CLEAR, NOT CLUTTERED AND SAFE

• EMERGENCY LIGHTING ALL WORKING AND IN ORDER

• ALL LICENSES, INSPECTIONS AND FILES UP TO DATE IN FOLDER

• OVERALL APPEARANCE OF THE BUILDING

• OVERALL SAFETY OF THE BUILDING

• IS THE STAFF ALL TRAINED AND UP TO DATE

• ALL CHEMICALS STORED AS THEY SHOULD BE

MISC NOTES

When walking through building, someone pointed something out:

Location Of Inspection

I sign to the fact that I completed a full and thorough walk-through of this facility and have carefully and meticulously examined each part of the building and these are my findings.