Room Inspection Form

Date you are filling out this form: *

Current time: *

Resident's First Name *

Resident's Last Name *

Reason for room search: *

Resident Notified of Room Search?: *

Yes

No

Date of Notification: *

Time of Notification: *

Resident Comments (if any):

Search conducted by (name & title; needs to be either the House Manager or House Lead): *

Witnesses Present (names & titles; can be House Lead or another resident): *

Describe Items or Conditions Found (if conditions acceptable or no prohibited items found enter "NONE"): *

Picture Upload (prohibited items, unsafe/unsanitary conditions, food/candy or wrappers in room or garbage cans, dirty dishes on room)

Disposition of any prohibited items found:

Room Inspection Form Resident Signature *

House Manager or Lead Signature *

Witness Signature: *