Facility:

  Inspected by:

Month:

  Inspection Date:

Date

Flag

Flag location

Flag Inspection Result

Issue Log: reason the flag is replaced  

☐  In good condition      ☐ Replace

Issue log:

☐  In good condition      ☐ Replace

Issue log:

☐  In good condition      ☐  Replace

Issue log:

☐  In good condition      ☐  Replace

Issue log:

☐  In good condition      ☐  Replace

Issue log:

☐  In good condition      ☐  Replace

Issue log: