Information

  • Conducted on

  • Prepared by

  • Swipe the screen to the left to start audit

  • Are men/women shaved?

  • Is oral care adequate?

  • Are residents wearing their glasses?

  • Are safety devices clean? (Lap buddy, seat belt, etc..)

  • Are wheelchairs clean?

  • Wheelchair armrests not cracked?

  • Are residents wearing approprite footwear?

  • Is attire approprite, clean, and in good repair?

  • If resident is a smoker, no burn holes in clothing?

  • Are call lights answered promptly?

  • Is fresh water with ice available and within reach?

  • Is resident privacy protected?

  • Does the room smell clean and fresh?

  • Do staff knock and wait for an answer before entering the room?

  • Is the room tidy and clean?

  • Is the floor clean?

  • Are the beds made properly?

  • Are personal items labeled and stored properly?

  • Are any bed pans/urinals properly labeled and covered?

  • Catheter tubing is not on floor and is in privacy bag?

  • Are paper towels available?

  • Is soap available?

  • Is there an O2 magnet on the door if required?

  • O2 tubing not on floor and in plastic bag?

  • Is the nebulizer mask in a bag?

  • Is the portable O2 filled?

  • There are no sharps in room?

  • Are skid strips in place and in good condition?

  • Is the call light within reach?

  • Is the call light positioned correctly?

  • Are splints/multi-podus boots on?

  • Is the bed in the lowest position?

  • Is the room clear of old room trays?

  • Do residents with room trays have adequate assistance?

  • Is the lighting adequate?

  • Is the refrigerator temp log current?

  • Is all the food in the fridge dated and current?

  • Extension cords are absent from the room?

  • No meds in drawers? Check after permission given

  • No meds at bedside?

  • Are O2 tanks in mesh bads and tubing not dragging?

  • Select date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.