Attachment 5 - Funeral Home Inspection Checklist.pdf

Attachment 5 – Funeral Home Inspection Checklist

Installation Date

Name of Funeral Establishment:

1. PREPARATION ROOM YES NO

A. SIZE - Size is adequate……………..……………………………………………….( ) ( )

B. EQUIPMENT - Adequate for treatment of remains………………………………...( ) ( )

C. INSTRUMENTS - Sufficient to prepare remains………………………………….. ( ) ( )

D. SUPPLIES - Sufficient for remains preparation…………………………………….( ) ( )

E. VENTILATION - Adequate ventilation……………………………………………..( ) ( )

F. APPEARANCE - Clean, orderly and free of extraneous items……………………..( ) ( )

2. STORAGE

HOLDING REMAINS - Funeral home has space for sheltering remains………………( ) ( )

3. PRIVATE CARRIER

TRANSPORTATION - Funeral home has a suitable funeral coach………………….... ( ) ( )

4. OTHER AREAS

A. CHAPEL - Funeral home has a satisfactory chapel………………………………… ( ) ( )

B. STATEROOM - Funeral home has a satisfactory stateroom for visitation………… ( ) ( )

C. OFFICE - Office is satisfactory……………………………………………………...( ) ( )

5. STANDARD CRITERIA

A. COMPLIANCE - Can meet all specifications, laws, and statutes on preparing remains…………………………………………………………………………………..( ) ( )

B. LICENSE - Funeral home and manager are currently licensed……………………..( ) ( ) C. STAFF - A competent professional staff is available…………………………….…( ) ( )

6. ESTABLISHMENT - EXTERNAL APPEARANCE

A. BUILDING - Exterior appears to be clean and well maintained……………………( ) ( )

B. GROUNDS - Grounds and parking areas appear to be well maintained……………( ) ( ) C. LOCATION- Surrounding area appears to be well maintained and comparable to the appearance of the majority of other area funeral homes………………………….( ) ( )

We, the undersigned, certify that the funeral home named above is ( ) is not ( ) acceptable to provide contractual mortuary services.

Contracting Officer:

Mortuary Officer/Other Officer: