• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Life Safety

  • Fire & smoke doors unobstructed, self close, synchronize, and latch?

  • Fire rated label on door and frame is present and legible?

  • Fire doors free of coverings and decorations (except formal signage)?

  • Doors closed where appropriate and not propped open?

  • Electrical panels in corridors are locked?

  • 18" of unobstructed space below sprinkler heads maintained?

  • EXIT signs working properly?

  • EXIT sign readily visible?

  • No items stored in hallway?

  • Fire extinguisher(s) and pull station(s) unobstructed?

  • Fire extinguisher tags are current?

  • Medical gas valves properly labeled with area served?

  • Notes:


  • No personal items left unsecured?

  • Area is well lit?

  • Door with access card reader is secure and functioning?

  • Access to secured areas labeled and restricted?

  • Photo ID's worn properly?

  • Notes:


  • Eyewash station unobstructed and working properly?

  • No stained ceiling tiles?

  • Doors are not propped open?

  • No slip and fall hazards?

  • Area is dust free (air vents, floors, lights, pictures, sprinkler heads, etc.)

  • Floor/ Carpet is clean and free of debris and stains?

  • Restrooms are clean and stocked?

  • Unapproved RPT's in use or Extension Cords used as permanent Wiring?

  • Gas cylinders are stored properly?

  • Hand rails/ grab bars secure and in good repair?

  • Purell dispensers over or within 6 inches of an ignition source?

  • Waste containers are not overflowing?

  • Cleaning supplies properly stored and labeled?

  • Notes:

Patient Care

  • Crash cart accessible and checked according to policy?

  • Laundry chutes closed and latched?

  • Medications secure, labeled and in date?

  • No Patient Food past expiration date?

  • No intermixed storage of staff and patient nourishment items?

  • Personal Protective Equipment (PPE) available?

  • Sharps containers at appropriate fill level and secured?

  • Supplies within acceptable date range?

  • Notes:


  • Parking lot and walkways have no uneven surfaces, pot holes or large cracks; free of debris?

  • Lighted signs and exterior lighting functional?

  • Notes:

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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.