How to use it
Rate each checkpoint, add notes where needed, then print for meetings, follow-up, or survey prep files.
Home Health Agency Survey Preparation Checklist
This dark-theme checklist helps home health and home care agencies review readiness before state surveys, accreditation reviews, and internal compliance audits. Complete it online, print a completed copy for documentation, or print a blank copy for manual review.
Best use case
Ideal for administrators, compliance teams, consultants, and new agency owners preparing for inspections or readiness reviews.
What it includes
Eight compliance categories, 56 checklist items, live scoring, criterion summaries, agency details, and printable notes.
Agency details
Fill these fields if you want the printed version to include identifying information. Leave them blank when printing a clean copy.
Overall readiness score
Each checklist item uses the same 4-point structure as the original worksheet: 4 = Excellent, 3 = Good, 2 = Fair, 1 = Poor.
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Interactive checklist
Work through each criterion below. Scores update automatically, and each section includes a notes area for evidence, corrective action, or missing documentation.
Printing tip: Use Print Completed Form to keep all entered information visible on paper. Use Print Blank Form to temporarily clear the fields, print a clean copy, and automatically restore your entries after printing.
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