• Document No.

  • Audit Title

  • Unit / Area

  • Conducted on

  • Prepared by

  • Personnel

Building Exterior - Drives, Parking, Overall Campus

  • Site lighting functioning properly?

  • Lighting turns on/off at appropriate times?

  • Parking lots are clear of debris / obstructions / tripping hazards?

  • Any standing water / ice in parking lots?

  • Appropriate signage to direct visitors / employees?

  • Signage visible at all times of day?

  • Campus fields are free of debris?

  • Are parking lots sufficiently salted / cleared during inclement weather?

  • Comments:

Building Interior

Building Interior

  • Are entrances well lit?

  • Entrance doors function appropriately?

  • Air curtains functioning at building entrances?

  • Is there sufficient signage at entrances?

  • Are public restrooms easily indentifiable?

  • Any hot / cold spots in hospital?

  • Are public areas sufficiently lit / any bad lights?

  • Flooring is not chipped / torn / damaged?

  • Flooring is not wet / slick?

  • Any damages / scrapes / marks on walls?

  • Any visibly discolored ceiling tiles?

  • Interior doors function properly?

  • Is there sufficient interior signage directing public?

  • All elevators function properly?

  • Did elevators annunciate correctly?

  • Are fire alarms and extinguishers sufficiently signed and accessible?

  • Are fire exit plans sufficiently posted?

  • Where any audible alarms heard during stay / rounding- if so was there a response of the staff?

  • Comments:


Staff Narrative

  • What was working well today?

  • Are there specific areas that need attention and why?

  • Are there any areas that should be recognized and what makes them notable?

  • Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address resolve the issue?

  • Is there anything we can do better?

Quarterly Focus

  • Was a specific task being performed (i.e. cleaning, floors buffed, facility maintenance, equipment repair, transport, food delivered / picked up, elevators, etc.)?

  • Did you identify anything that could affect the patient experience (lighting, signage, equipment making noise or rattling, loud talking, doors closing, etc)?

  • Do you have any recommendations to improve the issues you identified?

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