3000 420 150 r 4 11: Fill out & sign online

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Click ‘Get Form’ to open the document in the editor.
Begin by filling in the 'Facility' section with the name of your licensed care facility.
Complete the 'Type of Occupancy' field, specifying the nature of your facility.
Enter the 'Address', 'City', and 'Date of Inspection' accurately to ensure proper documentation.
For each inspection item listed under 'Exterior Building/Grounds', select 'Yes', 'No', or 'N/A' based on your assessment.
Continue through sections like 'Means of Egress' and 'Fire Rated Corridors/Doors', ensuring all responses reflect current conditions.
Once completed, review all entries for accuracy before saving or exporting your filled form.

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