Facility Checklist

Medical/General Interior

A thorough inspection of the internal facility to determine structural and operational readiness or to suggest maintenance and repairs to achieve readiness.

Date: ____________  Location: _______________________  Team member: __________________________

General (including condition of 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:
Operating rooms:
Intensive care units:

 

Estimated surge capacity:

 

Potential areas for ward use:

 

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