Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location


  • Roadways and Parking lot-Roadways are free from potholes and hazards.

  • Exterior Lighting- All parking areas, clients and employees are well lit. All approaches to building entrances are adequately lit for employees and clients. All property entrances are adequately lit for employees and the clients.

  • Exterior Signage - All lit signs are functioning and in good physical repair. All other signs are in good repair, neat and secure. The signage contains enough information to direct to facility services or proper policies for entry.

  • Walks, Sidewalks and Stairwells - The surfaces of walks are smooth in good repair and relatively level so as to pose no hazard to pedestrians. Shrubs, trees and planting's adjacent to walks pose no hazard to pedestrians using the walks.

  • General Grounds/Lawns - All areas of lawn have smooth contours and no holes or tripping hazards. Area is free of debris, trash, noxious plants and tall weeds. Trash cans are provided and are in good repair. All dead trees, dead limbs, or low overhanging limbs have been removed.

  • Surface Water Drainage - All storm drains are clear of trash and debris.

  • Exterior Building Features - Antennae, mast, towers and poles are secure. Exterior wall surfaces are in good repair. Exterior emergency exit doors are not obstructed.

Inspection - Interior

  • Walls are free from holes.

  • Entrances, exits and hallways are clear for movement of personnel, clients and materials.

  • There is no inappropriate use of extension cords or any exposed wiring.

  • Electric outlets are of the proper type and are not broken.

  • Electric switches are not broken or missing.

  • Broken items are taken out of use.

  • All items are stored safely. Nothing is too close to the ceiling blocking the sprinklers.

  • There is evidence of compliance with the smoking policy.

  • There is evidence of compliance with bio-hazard material policy.

  • The phone number for poison control is available to all employees.

  • Air condition vents are clean and dust free.

  • All bedroom doors close automatically and tightly per Joint commission standards.

  • All push doors are in proper and working order.

  • All freezers are in working order. None have frozen ice and have been properly defrosted if needed.

  • Water temperature is at normal level.

  • All windows and screens are secure.

  • Medications are securely locked.

  • Hazardous materials locked and in proper container.

  • Kitchen appliances and stove are in proper working order.

  • All washers and dryers are in good working order.

  • Escape routes and procedures are clearly visible.

  • First aid supplies are all available.

  • All exterior doors are locked.

  • All bathrooms are in good working order. Water pressure is appropriate. Bathrooms are clean and tidy.

  • General Safety- Temporary hazards (if any) are marked with signs/barricades. Wet floors, tree topping, maintenance, construction and parking lot activities.

  • Postings: Patient Rights, Confidentiality Laws and Grievance Procedure. Near the CA office, Hand washing signs, Medication room etc.

  • Licenses Posted- Business, DCF, Joint Commission and CLIA

  • Food storage is in proper order.

Inspection - Staff understanding of EOC

  • Can random staff name the codes or know where to find them?

  • Can the staff name their role and responsibility in hurricane preparedness?

  • Are staff aware of the locations of PPE and first aid?

  • Staff can locate the nearest fire extinguisher?

  • Can staff describe the meaning of RACE and PASS?

  • Can staff accurately describe policy of HIPAA and posting of information?

  • Staff member able to verbalize the proper procedures related to the completion of work orders and/or repair requests?

  • Staff member is able to verbalize at least 3 security measures in place organization-wide?

Safety Inspection Analysis

  • Findings- Elaborate on above.:

  • Recommendations/Actions:

  • Follow-up:

  • Print and Sign

  • Add any additional photos if needed

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.