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NEFTALY THERAPEUTIC PSYCHOSOCIAL SUPPORT PROGRAMME

HEALTH INSPECTION REPORT

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1. INSPECTION DETAILS

Item	Information
Programme Name	Neftaly Therapeutic Psychosocial Support Programme
Facility Name
Physical Address
Inspection Date
Inspection Time
Type of Inspection	☐ Routine ☐ Follow-Up ☐ Compliance ☐ Incident Related
Conducted By
Position / Organisation

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2. FACILITY INFORMATION

Item	Yes	No	Remarks
Facility clean and hygienic	☐	☐
Adequate ventilation	☐	☐
Sufficient lighting	☐	☐
Safe counselling environment	☐	☐
Floors clean and safe	☐	☐
Walls and ceilings maintained	☐	☐
Waste disposal available	☐	☐

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3. SANITATION & HYGIENE

Requirement	Compliant	Non-Compliant	Remarks
Clean toilets available	☐	☐
Handwashing facilities	☐	☐
Soap and sanitiser available	☐	☐
Safe drinking water	☐	☐
Cleaning schedule displayed	☐	☐
Cleaning materials stored safely	☐	☐

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4. HEALTH & SAFETY EQUIPMENT

Item	Available	Not Available	Condition
First Aid Kit	☐	☐
Fire Extinguishers	☐	☐
Emergency Exit Signs	☐	☐
Assembly Point Sign	☐	☐
Emergency Contacts Displayed	☐	☐
Incident Register	☐	☐

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5. COUNSELLING & THERAPEUTIC SPACE SAFETY

Requirement	Yes	No	Remarks
Confidential counselling rooms	☐	☐
Privacy maintained	☐	☐
Safe furniture	☐	☐
Child-friendly environment	☐	☐
No hazardous objects	☐	☐

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6. COVID / INFECTION CONTROL (WHERE APPLICABLE)

Requirement	Yes	No	Remarks
Hand sanitising stations	☐	☐
Cleaning procedures followed	☐	☐
Sick persons managed safely	☐	☐

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7. STAFF HEALTH & SAFETY COMPLIANCE

Requirement	Compliant	Non-Compliant	Remarks
Staff trained in safety procedures	☐	☐
Emergency evacuation plan available	☐	☐
Incident reporting system used	☐	☐
Safety induction conducted	☐	☐

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8. RISK IDENTIFICATION

Risk Identified	Level (Low/Medium/High)	Corrective Action Required

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9. CORRECTIVE ACTION PLAN

Issue	Recommended Action	Responsible Person	Deadline

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10. OVERALL INSPECTION FINDINGS

☐ Fully Compliant
☐ Partially Compliant
☐ Non-Compliant

Inspector Comments:

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11. FOLLOW-UP INSPECTION

Required	Date
☐ Yes
☐ No

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12. INSPECTOR DECLARATION

I confirm that this inspection was conducted in accordance with health and safety standards.

Inspector Name: __________________________

Signature: ______________________________

Date: ___________________________________

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13. PROGRAMME REPRESENTATIVE ACKNOWLEDGEMENT

Name: ______________________________

Position: ____________________________

Signature: ___________________________

Date: _______________________________

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✅ Recommended Supporting Documents

Attach where applicable:

• Safety Measures Manual
• Evacuation Plan
• Cleaning Schedule
• Incident Register
• First Aid Register
• Fire Equipment Certificates

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✅ Health Inspection File Structure

Health Inspection File
│
├── Inspection Reports
├── Corrective Action Plans
├── Follow-Up Reports
├── Safety Certificates
└── Compliance Records

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