• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Are gloves, gowns,eyewear and masks readily available?

  • Is clean line covered?

  • Is clean linen kept separate from the dirty linen disposal?

  • Are refrigerator maintained and up to date in medicine and patient refrigerators?

  • Are sharps containers under 2/3 rd full?

  • We're staff eating or drinking in designated areas only?<br>(food in not permitted where cross contamination can occure)

  • Is there no storage under sinks?<br>(only cleaning supplies may be stored under sink)

  • Are all open nutritional supplements marked with an open date?<br>(these supplements are only good for 30 days after they are open)


  • Are exit doors and stairwells clear and unobstructed?

  • Are exits clearly marked " EXIT" and fully illuminated?

  • Do fire doors latch properly?<br>(doors should have 3 point latching and have no more than 1/8 th inch gap between and 3/4 rd undercut)

  • Are corridors and passageways clear and unobstructed?<br>("IN USE" items are allowed in corridor when attended)

  • Are fire extinguishers, pull station and medical gas panels clear and unobstructed?

  • Are doors not propped/held open?<br>(door stops or other hold open devices are not permitted)

  • Are all material stored a minimum of 18" from sprinklers?

  • Are storage and equipment rooms free of clutter and unsafe conditions?


  • Is area free from evidence of smoking or other tobacco use?

  • Are the floor/hallways in good /safe condition?

  • Are the walls not in need of repairs or painting?

  • Are the ceiling tiles clean, stain free and in good condition?

  • Are heavy items stored at low/mid levels to avoid lifting injuries and fall hazards?

  • Are general areas clean and free of clutter?

  • Are compressed gas cylinders stored properly?


  • Are 2 prong extension cords removed from area?<br>(this style cord is prohibited and should be removed immediately)

  • Are telephone cords out of the way?<br>(to avoid tripping hazards)

  • Are mechanical, electrical and communication closets clean and free of improper storage?


  • Is medical waste kept in red biohazard bags and/or containers?

  • Is Regulated Medical Waste kept separate from normal trash?

  • Are secondary chemical containers labeled with product name, hazard label and manufacturer?

  • Are chemicals stored separately from patient contact or other clean patient items?

  • Are appropriate procedures, instructions or directions available for obtaining and using Material Safety Data Sheets (MSDS)?


  • Is staff personal items properly secured? (purses, wallets, keys)

  • Are all employees wearing their ID badges in plain veiw?

  • Are all eye wash stations functional and clean?

  • Are all medications kept in a secured room?

  • Is all patient information (electronic or paper) kept secure?


  • Does equipment not have any exposed wire (including plug)?

  • Is inspection on all medical equipment current?

  • Does the equipment cleanliness, paint, wiring and cover appear satisfactory?

  • Are all warmers functioning and set at correct temperature?

  • Are all code/crash carts checked and logged per manufacturer's specifications?


  • Staff knows what a "CODE TRIAGE" is?

  • Staff can explain what the Safety Committee is?

  • Staff know how/who to report defective equipment (medical/mechanical)?

  • Staff know how/who to report an accident or injury? Fill out an incident report?

  • Staff can speak to "National Patient Safety Goals?

  • Staff knows the location of the oxygen cut off valves? Who is responsible to turn them off?

  • Staff know the location of the MSDS book? How to obtain an MSDS?

  • Staff knows what a "CODE RED" is?

  • Staff can explain what R.A.C.E. means? What P.A.S.S means?

  • Staff knows the locations of nearest fire extinguishers? Fire alarm pull stations?

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.