BLOOD SYSTEMS: Donor

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Front Doors:

Back / Side Doors:

• Checked: Latch, closer, and seals.

  Yes

  No

  N/A

Lock Box:

• Checked: Lock box code and key in box.

  Yes

  No

  N/A

Lights

• Checked lights

  Yes

  No

  N/A

Ceiling Tiles

• Checked Ceiling tiles

  Yes

  No

  N/A

Interview Rooms

• Checked: Door glides and Latches

  Yes

  No

  N/A

Break Room

• Checked: Sink, tables, and chairs.

  Yes

  No

  N/A

Canteen

• Checked: Sinks, tables, and chairs:

  Yes

  No

  N/A

Women's Rest Room:

• Checked: Door latches and locks.

  Yes

  No

  N/A

• Checked: Faucets and toilets.

  Yes

  No

  N/A

• Checked: Clean exhaust fans vents as needed.

  Yes

  No

  N/A

Men's Rest Rooms:

• Checked: Door latches and locks.

  Yes

  No

  N/A

• Checked: Faucets, toilets, and urinals.

  Yes

  No

  N/A

• Checked: Clean exhaust fan vents as needed.

  Yes

  No

  N/A

Janitorial Closet:

• Checked: Sinks and drains.

  Yes

  No

  N/A

Safety and Compliance Items:

• Fire extinguishers in place.

  Yes

  No

  N/A

• Exit and Emergency Lights

  Yes

  No

  N/A

• Electrical panels are accessible.

  Yes

  No

  N/A

• Check for bugs in lights. Clean as needed.

  Yes

  No

  N/A

• Wipe down return grids. Change filters as needed.

  Yes

  No

  N/A

List of Repairs:

• Repairs completed:

  Yes

  No

  N/A

• Inspection items:

  Yes

  No

  N/A

• Pending:

  Yes

  No

  N/A

Notes:

• Comments:

  Yes

  No

  N/A