Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Life Safety
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Fire & smoke doors unobstructed, self close, synchronize, and latch?
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Fire rated label on door and frame is present and legible?
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Fire doors free of coverings and decorations (except formal signage)?
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Doors closed where appropriate and not propped open?
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Electrical panels in corridors are locked?
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18" of unobstructed space below sprinkler heads maintained?
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EXIT signs working properly?
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EXIT sign readily visible?
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No items stored in hallway?
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Fire extinguisher(s) and pull station(s) unobstructed?
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Fire extinguisher tags are current?
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Medical gas valves properly labeled with area served?
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Notes:
Security
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No personal items left unsecured?
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Area is well lit?
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Door with access card reader is secure and functioning?
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Access to secured areas labeled and restricted?
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Photo ID's worn properly?
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Notes:
Environmental
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Eyewash station unobstructed and working properly?
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No stained ceiling tiles?
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Doors are not propped open?
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No slip and fall hazards?
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Area is dust free (air vents, floors, lights, pictures, sprinkler heads, etc.)
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Floor/ Carpet is clean and free of debris and stains?
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Restrooms are clean and stocked?
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Unapproved RPT's in use or Extension Cords used as permanent Wiring?
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Gas cylinders are stored properly?
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Hand rails/ grab bars secure and in good repair?
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Purell dispensers over or within 6 inches of an ignition source?
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Waste containers are not overflowing?
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Cleaning supplies properly stored and labeled?
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Notes:
Patient Care
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Crash cart accessible and checked according to policy?
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Laundry chutes closed and latched?
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Medications secure, labeled and in date?
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No Patient Food past expiration date?
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No intermixed storage of staff and patient nourishment items?
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Personal Protective Equipment (PPE) available?
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Sharps containers at appropriate fill level and secured?
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Supplies within acceptable date range?
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Notes:
Exterior
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Parking lot and walkways have no uneven surfaces, pot holes or large cracks; free of debris?
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Lighted signs and exterior lighting functional?
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Notes:
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