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Station Inspection Form
Station Inspection Form
Name
This field is for validation purposes and should be left unchanged.
Date
MM slash DD slash YYYY
Station
Supervisor
Cariota
Adam
Jackson
Parks
Webb
Puerto
Kirkdorffer
Crutchfield
Pagel
Guillote
Tuttoilmondo
Other
Shift
A
B
C
D
Other/Event
In-Charge
Attendant
Third
Kitchen (Refrigerator/Cabinets/Microwave/Counters)
Quantity
Price:
$0.01
Quantity
Restroom (Toilet/Urinal/Sink/Shower)
Quantity
Price:
$0.01
Quantity
Floors (Swept and Mopped)
Quantity
Price:
$0.01
Quantity
Laundry (Laundry Complete/ Laundry area clean and organized)
Quantity
Price:
$0.01
Quantity
Trash (all trashcans indoor and outdoor/cigarette receptacles)
Quantity
Price:
$0.01
Quantity
Windows and furniture (blinds/dusting)
Quantity
Price:
$0.01
Quantity
Dorm Rooms (clean and tidy)
Quantity
Price:
$0.01
Quantity
Compliance (No visible PHI/no immediate safety issues)
Quantity
Price:
$0.01
Quantity
Other areas ( common area/lobby/bays)
Quantity
Price:
$0.01
Quantity
Daily Chores ( completed/in progress)
Quantity
Price:
$0.01
Quantity
Total
$0.00
Notes
In-Charge Email
*
Attendant Email
Supervisor Email
*
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