Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
HVAC
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Heating and Air Conditioning Unit
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Picture of Equipment.
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Type of Equipment:
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Room Location:
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Identifier:
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Make:
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Model:
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Serial Number:
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Condition
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Items that need attention:
Main Electrical Components
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Main Electrical Components
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Room Location:
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Identifier:
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Picture of equipment or device.
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Type of Equipment:
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Make:
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Model:
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Serial Number:
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Condition
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Items that need attention:
Piped Systems
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Main Piped Components
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Type of System:
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Location of System:
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Picture of system.
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Type of Piped Component
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Condition
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Items that need attention:
Exterior Building Components
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Building Component
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Type of Building Component
- Roof
- Building Masonry
- Doors
- Windows
- Chimneys or Flue
- Outside Vents
- Concrete Walks
- Sidewalks/Ramps
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Picture of building component.
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What is the overall condition?
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Items that need attention:
Horizontal Transport
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Elevator
- Roof
- Building Masonry
- Doors
- Windows
- Chimneys or Flue
- Outside Vents
- Concrete Walks
- Sidewalks/Ramps
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Type of elevator:
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Elevator Model:
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Has the elevator been inspected by the State?
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Take photo of any type of elevator information that might be required to notify the State.
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STATE NEEDS NOTIFIED AND AN INSPECTION IS NEEDED!!!!
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When was it last inspected? Needs to be yearly.
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Does everything appear to be in good working order?
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Photo's of items that need attention.
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Does the room appear to meet code requirements?
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Photo's of items that need attention.
General Room/Area Inspection
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Room
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Room Name:
- Bath
- Conferance
- Closet
- Corridor
- Entry
- Elevator Equiment
- Family Room
- DayCare
- Janitor
- Kitchenette
- Lobby
- Mechanical
- Office
- Passage
- Stairs
- Storage
- Suite
- Toilet
- Utility
- Vestibule
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Room Number:
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What is the condition of the fixtures?
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Photo's of items in question.
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What is the condition of the walls?
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Photo's of items in question.
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What is the condition of the ceilings?
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Photo's of items in question.
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What is the condition of the floors?
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Photo's of items in question.
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Does the door function properly?
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Photo's of items in question.
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Does the electric appear to be proper and functioning?
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Photo's of items in question.
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Does the exhaust appear to be working properly?
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Photo's of items in question.
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Is there anything else that needs attention?
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Photo's of items in question.
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What is the condition of the walls?
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Photo's of items in question.
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What is the condition of the ceilings?
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Photo's of items in question.
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What is the condition of the floors?
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Photo's of items in question.
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Does the door function properly?
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Photo's of items in question.
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Does the electric appear to be proper and functioning?
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Photo's of items in question.
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Does the room appear to meet code requirements?
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Photo's of items in question.
- Appliances
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Picture of apliance.
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Type of Appliance:
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Make:
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Serial Number:
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Model:
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What is the condition of the appliance?
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Items that need attention:
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Is there anything else that needs attention?
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Photo's of items in question.
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What is the condition of the walls?
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Photo's of items in question.
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What is the condition of the ceilings?
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Photo's of items in question.
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What is the condition of the floors?
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Photo's of items in question.
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Does the door function properly?
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Photo's of items in question.
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Does the electric appear to be proper and functioning?
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Photo's of items in question.
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Type of Equipment:
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Make:
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Serial Number:
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Model:
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What is the condition of the equipment?
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Items that need attention:
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Is there anything else that needs attention?
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Photo's of items in question.
Life Safety
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Are exit signs and egress lighting in place, tested, and operating properly?<br>Must be tested monthly.
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Photo's of items in question.
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Are the means of egress free of obstructions?
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Photo's of items in question.
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Are exit paths lit well?
