Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel

External Areas

  • Is the external building work in good condition

  • Were all windows clean

  • Was the refuse area clean and tidy and bins lidded and small bins emptied

  • Is the following areas free from dust, dirt, grit, leaves, cobwebs, rubbish, cigarette butts and bird excreta.

  • Entrances, landings, steps, ramps, porches, pathways, patios and outdoor furniture

  • Other Findings to be listed

Main entrance

  • Was the floor clean and in good condition

  • Were all lights in good working order

  • Is the furniture clean and in good state of repair

  • Is internal woodwork in good repair (including staircases, skirting and panelling)

  • Were all walls and ceilings in good condition

  • Other Findings to be listed

Public toilets

  • List public toilet areas that were reviewed

  • Was the vent allocation systems working and clean in all sets of cubicles

  • Were all the tiles and floors maintained and clean

  • Were the mirrors and vanity units clean and maintained

  • Were the sinks clean and in good condition, all taps working

  • Was the consumables stocked (hand towel/ soap dispenser)

  • Did all the toilet cubicles have a working lock and are graffiti free

  • Are baby changing facilities available, are they clean and in good state of repair

  • Are the toilets well maintained

  • Were the sanitary bins clean and not over used

  • Other Findings to be listed

Extreme area

  • Accident and emergency

  • Chemotherapy

  • Dialysis

  • Operating Theatres

  • Labour/delivery room

  • Other

  • List other areas here

  • The elements need to meet the criteria as follows: free from dust, soil, grit, mould, stains, cobwebs,insects, film and other components that would inhibit regular cleaning process from being undertaken.

  • Ceilings, high areas, moulding and curtain rails

  • Ducts, grills and vents

  • Windows

  • Internal walls and skirting boards

  • Doors

  • Handbasins and taps

  • Hard floors

  • Soft floors including carpets, carpet tiles and floor mats

  • Other Findings to be listed

Extreme Area - Fixtures

  • Furnishings and fixtures

  • Kitchen/ beverage bay (patients)

  • Kitchenette /beverage bay (staff)

  • Bathroom and toilet fixtures

  • Electrical fixtures and appliances

  • Other Findings to be listed

Extreme Areas - Patient related equipment

  • Patient bed

  • Bedside wall mounted equipment

  • Patient furniture

  • Medical equipment

  • Other Findings to be listed

Extreme Areas - Environmental

  • Waste receptacles

  • General issues - other

High Risk Areas

  • Sterile stock storage

  • Pharmacy clean area

  • General ward areas

  • Outpatient clinic

  • Other areas list here

  • The elements need to meet the criteria as follows: free from dusts, soil, grit, mould, stains cobwebs, insects, lint, film and other components that would inhibit regular cleaning processes from being undertaken.

  • Ceilings, high areas, mouldings and curtain rails

  • Ducts, grills and vents

  • Windows

  • Internal walls and skirting boards

  • Doors

  • Hand basins and taps

  • Soft floors including all carpets, carpet tiles and floor mats

High Risk Area - Fixtures

  • Electrical fixtures and appliances

  • Furnishings and fixtures

  • Kitchenette/beverage area (patient)

  • Kitchenette / beverage area (staff)

  • Bathrooms, toilets and fixtures

  • Other Findings to be listed

High Risk - Patient Related Equipment

  • Patient furniture

  • Patient bed

  • Other Findings to be listed

High Risk - Environmental

  • Waste receptacles

Medium Risk Areas

  • Day activity area

  • Residential accomodation

  • Laboratories

  • Medical imaging

  • Offices in patient areas

  • List any other areas here

  • The elements need to meet the criteria as follows: free from dusts, soil, grit, mould, stains cobwebs, insects, lint, film and other components that would inhibit regular cleaning processes from being undertaken

  • Bathroom and toilet fixtures

  • Ceilings, high areas, mouldings, curtain rails and other high areas

  • Ducts, grills and vents

  • Windows

  • Internal walls and skirting boards

  • Doors

  • Handbasins and taps

  • Hardfloors

  • Soft floors including all carpets, carpet tiles and floor mats

  • Other Findings to be listed

Medium Risk - Fixtures

  • Electrical fixtures and appliances

  • Furnishings and fixtures

  • Kitchenette / beverage area (staff or patient)

  • Bathroom and toilet fixtures

  • Other Findings to be listed

Medium Risk - Patient Related Equipment

  • Patient bed

  • Bedside wall mounted equipment

  • Patient furniture

  • Medical equipment

  • Other Findings to be listed

Medium Risk - Environmental

  • Waste receptacles

  • General/other issues

Other areas not included above

  • Were other storage room clean and organised

  • We're all light in good working order

  • Were corridors mopped, swept and in good condition

  • Were staff amenities clean and tidy with stocked hand wash facilities

  • Were offices clean and tidy

  • Were staff observed to be adhering to required practices

  • Other Findings to be listed

Cleaning Program

  • Has the facility implemented the Environmental Cleaning Program

  • Is evidence available to meet all criteria within the program

  • Are all records current and up to date

  • Has correct risk zoning been implemented

  • Other Findings to be listed

Cleaning Schedules

  • Is there cleaning schedules allocated for each shift duty. Cleaning schedules should not be shared among cleaning shift

  • Are Cleaning schedules reviewed

  • Are there any lapses in documentation. Has there been any corrective actions documented. Where days are not signed off have the area been cleaned the day after? Is the area evident of being clean?

  • Is the facility reflective of the cleaning schedules eg all duties signed off as completed reflect the condition of the facility

  • Other Findings to be listed

Environmental Cleaning Audit

  • Where a low score has been achieved have appropriate corrective actions been recorded

  • Is there evidence that the Audits are being managed at a facility meeting. Evidence would include meetings with a standing agenda item

  • Have audit results been submitted to area for review

COVID-19 Check

  • Are high contact surfaces and touch points being disinfected regularly

  • What chemical is currently being used at the facility. Is it compliant and being used correctly

  • Are staff wearing correct PPE and prescribed uniform

  • Are staff washing hands at correct times appropriate to their cleaning duties

  • Do staff have ready access to handwash and or soap, running water and paper towel and/or alcohol rub

  • Is there evidence of training for all staff on chemical handling, storage and disposal. In particular for ChlorClean and ViraClean

  • Are requirements for Covid cleaning adheared to for risk category

  • Is additional Covid cleaning documented in cleaning schedule or similar approved?

  • Other Issues for discussion

Signature

  • Add signature

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