• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Client information

  • Client name

  • Add location

Changes in details

  • Have you changed your telephone number?

  • Has there been any changes to your emergency contacts and NOK?

  • Has there been a change in doctors etc.?

  • Are there any changes in accessing the property? (I.e key codes etc.)

Changes in health

  • Are there any changes in mobility?

  • Have there any changes in medication?

  • Please list current medication taken?

  • Are these changes recorded in the care plan?

  • Are there any changes in the client's skin integrity?

  • Add a photo if applicable?

  • Does the client have any pressure areas?

  • Add a photo if applicable?

  • Are there any changes in the capacity of the client's senses (eg eyesight, hearing) and communications skills?

  • Is the client fully continent? If not, please if urine incontinent or fecal or both. Are any incontinence products used?

  • Has the client had any falls since the last review?

  • General comments:

Food and drink

  • Does the client eat well?

  • Who prepares the client's food?

  • Self

  • Carer

  • Family

  • Meals on wheels etc

  • Does the client drink well?

Changes to the living environment?

  • General comments:


  • Does the service user use a hoist or bath lift? If yes, enter date of last service.

  • Any other equipment used? Please add details.

Further action?

  • Does the care plan continue to meet the needs of the service user?

  • Are all care plans and risk assessments up to date?

  • Any further action required?

  • Please detail if yes.

  • Client signature

  • Date

  • Assessor signature

  • 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.