Template Information
Physical site survey for current plan conditions and repairs.
Category: general
Template Questions
- Describe the general impression of the facility:
- Is the facility sign in good condition?
- How Many Occupied Building?
- Is the facility free from any Asbestos containing material?
- Does the front entrance have an automatic opening door that is ADA compliant?
- What type of construction is the exterior of the facility?
- What is the condition of the paint and finish on the exterior of the building?
- What type of windows are installed?
- Are all windows double pane?
- What is the general condition of the parking lot(s)?
- All areas in good condition with no needed repairs?
- What condition is the parking lot line striping?
- Are all ADA Markings or signs clear and to code?
- How many Parking Slots are on the property(non-ADA)?
- What is the general condition of the facility sidewalks?
- Are all sidewalks in good condition with no needed repairs?
- Does the facility use a trash compactor?
- What is the general condition of the facility landscaping?
- Who is the facility landscape contractor(provide contact number)?
- Is there a functioning irrigation sprinkler system?
- Does the facility have any fences on the property?
- What is the general condition of the roof?
- Describe the roof composition(3-tab, membrane, tile ect.) of each section as appropriate and age:
- Roofs are free from ponding or standing water?
- Does the facility have an emergency generator?
- What is the general condition of the Fire Alarm system?
- Make:
- Has the system been service in the last 12 month, and no deficiencies or repairs needed?
- Model:
- FACP Location:
- Installed Date:
- Is the Fire Alarm system Addressable or Zoned?
- How many nurse call systems are in the facility?
- Describe the general condition of the nurse call system(s)
- Is the nurse call system operational with no needed repairs?
- Does the facility have a dedicated reception area?
- What is the condition of the flooring in the lobby area (take picture and note type of material)?
- Is the lighting in the common spaces adequate?
- What is the general condition of the handrails?
- Are all resident door and bathrooms ADA lever set door knobs?
- Does the staff have any concerns regarding security?
- What is the general condition of the resident rooms?
- Describe the flooring type and age for the resident room and bathrooms:
- What is the general condition of the plumbing fixtures in the resident rooms?
- Please describe any additional repairs or equipment needed and provide photo graphs and documentation as appropriate:
- What is the general condition of the kitchen?
- Is the kitchen clean and organized?
- What type of suppression system is installed in the kitchen hood?
- Has the kitchen hood and suppression system been inspected every 6 months by a service company?
- Is the facility dish machine owned or leased?
- Is the dish machine a high temp (booster) or low temp (chemical injection) machine?
- Are the facility ice machines drained, cleaned, and filters checked quarterly?
- Does the facility have a deep fryer?
- In the last 12 months has the facility had any issue with buildup of any Fats, Oils, or grease issues requiring service work?
- How many Reach-in Refrigerators are onsite?
- Refrigeration Equipment is in good condition and needs no repairs or replacements?
- Does the facility have an on-site laundry?
- Facility has no identified electrical issues?
- How many water heaters are on site?
- How many boilers are on site?
- Is the water management plan and flow diagram accurate?
- What is the general condition of the water heating systems?
- Describe the types of water heating or boiler equipment is in service?
- Facility needs no additional water heating related equipment repairs or replacements?
- How many mixing valves are in operation, major distribution, showers. (not tempering valves i.e. sinks)
- Does the facility have a water softening system?
- Does the Facility have any plumbing or sewer repairs presently?
- What is the general condition of the HVAC systems in the facility?
- Are there any specific HVAC unit repairs or replacements needed?
- Are all the HVAC units labeled indicating coordinating systems?
- Resident Room heat is provided by what type of system(select all as needed)?
- Resident Room Cooling is provided by what type of system(select all as needed)?
- Does the facility have defined plans to provide alternate heating / cooling during extreme weather?
- Does the facility have an elevator?
- Facility Identified Top 5 Capital Projects:
- Describe Scope and budgeted cost of project:
- Pictures supporting project.
- Please document any other facility issues:
- Add media