Title Page

  • Audit Title

  • Conducted on

  • Inspected By

  • Location
  • Entrance to Area/Division Clean and Presentable? (Overall First Impression of area/unit)?<br>

  • Disinfection wipe container lids closed and labeled correctly? Chemical Dispensing unit in working condition?

  • Eye Wash sheets properly dated? (Unblocked)

  • Hopper rooms clean and in order? (No unnecessary items)

  • Housekeeping carts clean and free of unnecessary item?

  • Equipment clean? (Vacuums, buffers & carts)

  • Staff have knowledge of R.A.C.E. (Rescue Alarm Contain Extinguish) and P.A.S.S. (Pull Aim Squeeze Sweep.)?

  • Staff have knowledge of Dwell time for Disinfectant? (Name of Disinfectant)

  • Does staff have knowledge of SDS? What is SDS? (Safety Data Sheets) Where is the SDS information located?

  • P.P.E. Available? (Gloves, Goggles is there evidence of use?)

  • Staff have knowledge of location of Fire Pull Stations?

  • Soiled Utility rooms cleaned & organized?

  • Green Trash & Red Bio Hazard carts cleaned & lined? (McClure Carts)z

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.