Blood Systems Inc

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

MAIN ENTRY DOOR

• Check door and latches for proper operation

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Check operation of door closer

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Check door seals and gaskets for gaps

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Notes

SIDE AND BACK DOORS

• Check door and latches for proper opperation

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• check operation of door closer

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Check door seals and gaskets

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Notes

LIGHTS AND CEILING TILES

• Inspect lights and replace as necessary

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Inspect ceiling tiles for stains and in place

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Notes

INTERVIEW ROOMS

• check door glides and latches for proper operation

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

BREAK ROOM AND CANTEEN

• check sink, faucets and drains

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

WOMAN'S RESTROOM

• Check door handles and locks

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Check faucets and toilets

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Clean exhaust fans as needed

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

Men's restroom

• Check door handles ans locks

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Check faucets, toilets, and urinals

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Clean exhaust fans as needed

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

SAFETY AND COMPLIANCE ITEMS

• Fire extinguishers securely in place

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Exit and emergency lighting are working

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Electrical panels are accessible

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Clean out bugs in light fixtures as needed

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Wipe down return grills as needed

  Select Checked Needs repair yes no repaired replaced light replaced tile cleaned

  • Checked
  • Needs repair
  • yes
  • no
  • repaired
  • replaced light
  • replaced tile
  • cleaned

• Notes

• Pictures

  Media

• Inspectors signature

  Sign