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Agency for Healthcare Research Quality www.ahrq.gov
www.ahrq.gov

Facility Checklist

Facilities/Ancillary Services

Availability of other space for ancillary services. Examine general condition of facilities. Other experts will look at these areas from a different perspective.

Date: ____________  Location: _______________________  Team member: __________________________

Administrative Areas

 

Observations:  

 

General condition:  

 

Description of Structural Components

Floors:  
Ceilings:  
Windows:  
Doors:  
Missing or damaged structural components (note location):  

 

Pests/Mold

Description and location:  

 

Communication Services

Telephone ports:  
Data ports:  

 

Lighting:  

 

Y N Fire suppression?

 

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AHRQ Advancing Excellence in Health Care