Grad Cabin Room Inspection

Inspector / Staff Name

First NameLast Name

Date

GC Room Number and Side

Areas of Concern (mark ALL that apply):

Please elaborate on the areas of concern marked above:

Take Photo

Inspector / Staff Signature

* OFFICE USE ONLY *

Discipline Given:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Program Director Signature:_______________________ Date:__________

Campus Pastor Signature: ________________________ Date:__________

GC Resident Signature:___________________________ Date:__________