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Funeral Home Facilities Inspection Checklist
VAMC: _______________________________ Date of Inspection: ___________________
Name and Address of Funeral Home: ______________________________________________
Check each item inspected. Write comments in the space provided or use another sheet of paper.
| # |
| Description of Items |
| Yes |
| No |
Preparation Room
| 1 |
| Size - Is the size adequate? |
| 2 |
| Equipment – Is it adequate for treatment of remains? |
| 3 |
| Instruments – Is it sufficient to prepare remains? |
| 4 |
| Supplies – Is it sufficient for remains preparation? |
| 5 |
| Ventilation – Is it adequate? |
| 6 |
| Appearance – Is it clean, orderly and free of extraneous items? |
Storage Area
| 1 |
| Holding Remains – Is there adequate space for remains? |
Private Carrier (Transportation)
| 1 |
| Types of transporter – View the types and are they adequate? |
Other Areas
| 1 |
| Chapel – Is it satisfactory? |
| 2 |
| State Room – Is it satisfactory for visitation? |
| 3 |
| Office – Is it satisfactory to conduct business? |
Standard Criteria
| 1 |
| Compliance – Does the funeral home meet specifications, laws and statues on preparing the remains? |
| 2 |
| Licensed – Is the home and manager currently licensed? |
| 3 |
| Staff – Is staff professional and competent? Available? |
Establishment – External appearance
| 1 |
| Building – Is the exterior clean and well maintained? |
| 2 |
| Grounds – Are the grounds and parking areas well maintained? |
| 3 |
| Location – Is the surrounding areas well maintained and comparable to areas surrounding majority of local funeral homes? |
Comments by Evaluator:
We, the undersigned, certify that the funeral home named above is ( ) is not ( ) acceptable by the VA Medical Center to provide contractual mortuary services.
| Contracting Officer: _______________________________ | Date: ________________________ |
| VAMC Representative: __________________________ | Date: __________________ |
