NEFTALY THERAPEUTIC PSYCHOSOCIAL SUPPORT PROGRAMME
HEALTH INSPECTION REPORT
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 |
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 | ☐ | ☐ |
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 | ☐ | ☐ |
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 | ☐ | ☐ |
5. COUNSELLING & THERAPEUTIC SPACE SAFETY
| Requirement | Yes | No | Remarks |
|---|---|---|---|
| Confidential counselling rooms | ☐ | ☐ | |
| Privacy maintained | ☐ | ☐ | |
| Safe furniture | ☐ | ☐ | |
| Child-friendly environment | ☐ | ☐ | |
| No hazardous objects | ☐ | ☐ |
6. COVID / INFECTION CONTROL (WHERE APPLICABLE)
| Requirement | Yes | No | Remarks |
|---|---|---|---|
| Hand sanitising stations | ☐ | ☐ | |
| Cleaning procedures followed | ☐ | ☐ | |
| Sick persons managed safely | ☐ | ☐ |
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 | ☐ | ☐ |
8. RISK IDENTIFICATION
| Risk Identified | Level (Low/Medium/High) | Corrective Action Required |
|---|
9. CORRECTIVE ACTION PLAN
| Issue | Recommended Action | Responsible Person | Deadline |
|---|
10. OVERALL INSPECTION FINDINGS
☐ Fully Compliant
☐ Partially Compliant
☐ Non-Compliant
Inspector Comments:
11. FOLLOW-UP INSPECTION
| Required | Date |
|---|---|
| ☐ Yes | |
| ☐ No |
12. INSPECTOR DECLARATION
I confirm that this inspection was conducted in accordance with health and safety standards.
Inspector Name: __________________________
Signature: ______________________________
Date: ___________________________________
13. PROGRAMME REPRESENTATIVE ACKNOWLEDGEMENT
Name: ______________________________
Position: ____________________________
Signature: ___________________________
Date: _______________________________
✅ Recommended Supporting Documents
Attach where applicable:
- Safety Measures Manual
- Evacuation Plan
- Cleaning Schedule
- Incident Register
- First Aid Register
- Fire Equipment Certificates
✅ Health Inspection File Structure
Health Inspection File
│
├── Inspection Reports
├── Corrective Action Plans
├── Follow-Up Reports
├── Safety Certificates
└── Compliance Records
