Assisted Living Inventory List Printable

Thursday, July 10th 2025. | Inventory List

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Assisted Living Move-In Inventory Checklist

Assisted Living Move-In Inventory Checklist

This inventory checklist is designed to document the condition of the resident’s apartment or room at the time of move-in. Both the resident (or their representative) and a staff member should complete and sign this form. This helps protect both the resident and the assisted living facility by providing a record of the condition of the space and the items brought in.

Instructions:

  1. Inspect each item or area carefully.
  2. Indicate the condition of the item/area using the following codes:
    • N = New
    • G = Good
    • F = Fair
    • P = Poor
    • NA = Not Applicable
  3. Note any specific damages or issues in the “Notes” column.
  4. After completing the checklist, both the resident (or representative) and a staff member should sign and date the form.
  5. Keep one copy of the completed checklist for the resident’s records and one copy for the facility’s records.

Resident Information

Resident Name:
Apartment/Room Number:
Move-In Date:

Apartment/Room Condition

Item/Area Condition Notes
Walls
Ceiling
Floor
Windows
Window Coverings (Blinds/Curtains)
Door(s)
Lighting Fixtures
Outlets/Switches
Smoke Detector
Sprinkler System (if applicable)
Heating/Cooling System

Bathroom Condition

Item/Area Condition Notes
Toilet
Sink
Shower/Bathtub
Shower/Bathtub Door or Curtain
Mirror
Flooring
Towel Racks
Grab Bars (if applicable)
Ventilation Fan

Kitchenette Condition (if applicable)

Item/Area Condition Notes
Cabinets
Countertops
Sink
Refrigerator
Microwave
Stove/Cooktop (if applicable)

Resident’s Personal Property Inventory

List all significant personal items brought into the apartment/room by the resident. This list does not need to be exhaustive, but should include valuable or easily damaged items such as electronics, furniture, and jewelry. Include a brief description and note the condition of each item.

Item Description Condition Notes

Add more rows as needed. For valuables, consider taking photographs for additional documentation.

Additional Notes

Please use this space to note any other observations or concerns regarding the condition of the apartment/room or the resident’s belongings:

Signatures

By signing below, both the resident (or their representative) and a staff member acknowledge that they have inspected the apartment/room and agree with the documented condition.

Resident (or Representative) Signature:

Date:

Staff Member Signature:

Date:

This inventory checklist is intended as a guide and may need to be adapted to meet the specific needs of the assisted living facility and its residents. It is not a substitute for legal advice.

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