Facility Checklist

Administration/General Interior

Date: ____________  Location: _______________________  Team member: __________________________

General Facility (Overall facility, including condition of the interior, space, number of rooms, licenses, current uses and age.)

 

Observations:

 

Current approved uses:

 

Location:
Hours:
Current licensing/accreditation (if any):
Estimated interior square footage:
Original patient capacity:

Number of rooms

Patient:
Emergency:
OR:
ICU:

 

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