Title Page

  • Company

  • Inspector

  • Conducted on


  • Is there loose material, debris, worn carpeting?

  • Are the floors slippery, oily or wet?

  • What is the condition of the general flooring?

  • Are there any uneven levels of flooring?


  • Are all the lights in good working order?

  • Are bulbs missing?

  • Are any areas dark?

Stairways and Aisles

  • Are they clear and unblocked?

  • Are stairways well lighted?

  • Do the stair ways have the capping on the edges?

  • Are they in good condition?

  • Inspector's reference: This is an example of unblocked stairways. You can also attach/take photos and annotate them using iAuditor.

  • feee stairway.jpg
  • Are handrails, handholds in place?

  • Are the aisles marked and visible?

Emergency Equipment

  • Is all fire control equipment regularly tested and certified?

  • Is fire control equipment appropriate for the type of fire it must control?

  • Is emergency lighting in place and regularly tested?

  • Are doors holding with fire mag holders?

  • Are fire blankets in the correct places?

  • Are first aid boxes in the correct locations, tested and in good working order?


  • Are washrooms and food preparation areas clean?

  • Are the following provided adequately?

  • - bed room toilets and communal

  • Describe the locations that are not clean and sanitised and require attention.

  • - showers

  • - clothing storage / wardrobes

  • - kitchen

  • - dining room

  • - gym

Maintenance (outside and inside)

  • Are doors and locks in good working order?

  • Are ceiling tiles intact, undamaged and in place?

  • Are there no signs of weather damage or mold growth in the facility?

  • Are all windows unbroken and free from any type of damage?

  • Do air conditioning vents and ducts appear to be clean upon visual inspection?

  • Are outside lights in good working order?

  • Does the exterior of the building present no safety concern?

  • Is the parking lot area free of any safety concern? (i.e. overgrown landscaping, uneven pavement, traffic hazards)


  • Are aisles, doorways and corners free of obstructions to permit visibility and movement?

  • Are chairs in safe condition and are caster, rungs and legs sturdy?

  • Are all equipment and supplies in their proper places?

  • Is there adequate walking and egress clearance?


  • TSS is the organisation that controls, certifies and manages High View Care Centre.

    Screenshot 2023-01-25 at 15.41.24.png
  • Is the access control in good working order?

  • Do entry and exit procedures provide workers personal security at night?

  • Has the access control been certified and checked? (TSS)

  • Are emergency (evacuation, fire, hostile person) procedures in place?

  • If any of the above is not completed, you must arrange to contact TSS and organise for this to be completed.


  • Additional recommendation

  • Full Name & Signature of Inspector

Action Plan

  • Please detail below any actions that you have put in place as part of your risk assessment. If action is not required, put NOT REQUIRED in the submission field.

  • Floors

  • Lighting

  • Stairways and Aisles

  • Emergency Equipment

  • Sanitisation

  • Maintenance

  • General

  • Security

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.