Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

2024 Site Inspection

  • "Have ready for review or scan and upload, email prior to arrival. Two weeks to prior visit, communicate request - deadline for response email = 3 business days before arrival.

Pre Visit Work

  • 1 Have team members participated in a building evacuation/fire drill within the last 12 months. Drill conducted within 45 days of a facility move.

  • 2 New team member participated in an evacuation drill within 30 days of employment.

  • 3 Post disaster evaluation forms drill/evacuation completed within last 12 months. Disaster documents available for review.

  • 4 Safety meeting and local training rosters are available for review.

  • 5 Most recent self-inspection and improvement plan available for review. (Paper or digital – keep rolling 6 months)

  • 6 Most recent audit report and associated documents indicating status of findings. (Paper or digital report - keep until next scheduled audit)

  • 7 Check in with team on MyLearning course status

  • 8 Are 4 most recent Pest control reports availble?

  • 9 Are the 4 most recent Ecolab reports availble?

Safety Checks

  • 10 Locally developed Emergency Evacuation Route/Map

  • 11 Emergency Procedures Flip Chart - Completed with current management information, availble at each entrance.

  • 12 Appropriate exit signs

  • 13 Emergency lighting signage identifying all emergency lights.

  • 14 First aid signage posted by first aid kits

  • 15 Current hazard communication SOP (unless located within SDS binder) SOP-SVC-US-0046 on NA site

  • 16 Chemical solutions and or Hazardous substances are clearly labeled with hazard and expiration dates and stored properly. (e.g. EcoLab chemicals)

  • 17 Any chemical solutions that is taken out of its original container must be properly labeled with the product in the bucket/container and have a HMIS/WHIMS label (includes cleaning cart buckets).

  • 18 Chemical spill kit is available, and employees know how to use it. (Check shelf life)

  • 19 Flammable liquids kept in closed containers and stored in an approved fire locker. (if needed)

  • 20 Fire extinguisher signage identifying fire extinguisher locations ABC fire extinguishers, mounted, identified and fully charged. Annual tag documented with monthly check dates.

  • 21 Eye Wash Station has identifying and visible posting, drains properly, covers and unit are clean and calcium free – eye wash station checks correctly documented

  • 22 Processing area has appropriate slippery floor or equivalent posting for when there is a potential for wet/slippery floors.

  • 23 All used batteries stored properly in closed plastic container with vented lid


  • 24 Geotab telematics device installed and working.

  • 25 Service Consultants know how to view previous DVIR in Geotab Drive. Hard copy DVIR on file for 90 days.

  • 26 Check prior day's DVIR report for Pre/Post trip Inspections. Verify there are no missing inspections when comparing to truck trips in GeoTab.

  • 27 If using hard copy DVIR, required DVIR in vehicle: Previous driver DVIR; Current driver DVIR

  • 28 All required team members compliant with use of Truce

  • 29 Vehicle maintenance up to date – no past due PMs or required inspections.

  • 30 Vehicles have a binder with all the required documents.

  • 31 Truck cab/exterior is clean and free of trash and debris.

  • 32 PPE located in vehicle along with First Aid Kit.

  • 33 Fire Extinguishers are in cab and fully charged; emergency triangles are available.

  • 34 Truck cargo area is clean and all equipment loading and functioning.

  • 35 Required equipment to secure frames is available, including foam for truck sides.

  • 36 View all truck cargo area posting: Loading Inventory Diagram; Wall Position Loading Diagram ; Proper Use of Ratchet

  • 37 Observation of product loaded appropriately.

  • 38 Dirty/clean product is clearly identified and separated.


  • 39 Warehouse is clean and organized *Clear evidence of bi-monthly mopping *All trash bins and laundry carts have clean liners and/or plastic liners are replaced daily *Evidence of daily mopping and trash bins emptied in Processing area

  • 40 T-Card System is being used correctly. Initialed and dates showing.

  • 41 Evidence of appropriate signage in all locations.

  • 42 Quality processing observation of team member. If Contract Worker have they been trained correctly?

  • 43 All products not currently be worked on are appropriately covered; blue for dirty/clear for clean.

  • 44 Processing carts have needed supplies, are neat and labeled. Correct HMIS for One Step and Two Step.

  • 45 Team members are wearing appropriate PPE. Are they wearing it outside of the Dirty and Processing areas?

  • 46 Tools/Test equipment are appropriately stored in Processing and Repair areas and available for use.

  • 47 Weights are labeled and verified---100g weight available if needed.

  • 48 Mattress tester has current PM label and correct log is in use.

  • 49 (if required) Steri-Fab sprayers have marbles for proper disbursement. Correct log being used and completed correctly. Law labels available.

  • 50 Down tag check – product handled appropriately within requirement timeframe. Products in repair must be covered in clear plastic with a copy of the completed Inspection Lot and Down Tag indicating the required repair and any parts ordered.

  • 51 All parts are easily viewed and clearly labeled.

  • 52 Repair area and parking bays are clean and orderly.

  • 53 Random Check of Ready assets: *Product is clean and covered with clear plastic *Copy of Inspection Lot found on product *QRG attached/ QR codes appropriately located *Blue return cover included*Correct labels on product; LOOK for new Arjo Rental Sticker *Battery and PM dates are not expired/past due *Box units are in clear plastic bags on top of the plastic bed cover w/Inspection Lot visible *Beds are in Transport configuration; Collapsed to transport length, mattress deflated and siderails lowered on Citadel, Frame is lowered.

  • 54 Random check with team member on knowledge of how to find: controlled procedures, SDS website or other online tools. List team member name and action performed below:

  • 55 Any competency gaps at SVC?

  • 56 Employees understand customer complaint proces - how service swaps are handled?

  • 57 Overall, any notable observed issues?


  • 58 Review MyMediset / Reservation Monitor for any issues. What are the daily practices for managing open and aging orders? WI-SVC-US-0122

  • 59 Review IW73 / IW72 for any pending order issues. What are the daily practices for managing open and aging orders?

  • 60 Download report from either IH08 or Z15_D102 for storage location 9100 (Quality Processing) Review to ensure assets are in the proper location, take action on all aging orders and review items in bedstore over 30 days

  • 61 Are all products in dirty storage found in the report? What is the process for reconciliation?

  • 62 Box units needing repair have been shipped to designated depot and transferred correctly in SAP. (Weekly basis) If Box units are still in SVC do they have a correctly completed Down Unit Tag including FTRE.

  • 63 Product disposal – check paperwork and SAP SO for correctness. No evidence of scrapped products >60 days repair.

  • 64 All shipments from distribution warehouse are opened, verified and received in SAP. (received parts should have note for FRT or placed in appropriate storage location)

  • 65 Review most recent past inventory report. All missing assets been located and/or reconciled.

  • 66 All product files are available. (Look at a small sample size, 10-15 Serial numbers) Check on 2 PM documents that you pull from Sample -verify both electronic and hard copy files. Check Power BI for most recent ZSM and verify the PM Inspection Lot is attached to the SO in SAP. Review for PM Date in Class Overview:

  • 67 Random selection of 2 ZSM order and review for failed ZRCE thourgh service order completion

  • 68 Review 2 FTRE's or RE3 service orders from Oxando through repair. (see WI-SVC-US-0141-A)

  • 69 Team members demonstrate knowledge and skill with all required SAP transactions. Are Contract Workers present? Do they have an SAP Login and have they been trained to transact a Hygiene order? Review hygiene transactions, truck movements, SO transactions and overall documentation.

Transform to Perform 30 Day Follow Up

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.