Title Page

  • Location/Room #

  • Conducted on

  • Manager Conducting Audit

  • EVS Staff Member Assigned

Door Surfaces

  • Frames and Top Edges

  • Push Plates and Handles

  • Hinges

Walls/Wall Hangings

  • Light Switches

  • Pictures/Frames

  • TV/Bracket

  • Clocks


  • Lights Clean

  • Vents are clean and free of dust on outsides

  • No visible spots on Ceilings/Tiles

Horizontal Surfaces

  • Counters

  • Ice Machines

  • Shelves/Cabinet Tops - free of dust

  • Fire Strobe Lights/Exit Lights - Free of dust

  • Phone and Cord - Clean and Organized

  • Railings and Ledges - Free of Dust


  • Glass Doors

  • Windows - No Smears

  • Window Sills

  • Mirrors - No Marks

  • Blinds/Curtains - No Spots


  • Chairs/Sofas clean including the legs

  • Tables and Legs

  • Lamps/Shades

  • Garbage Cans - Clean, Extra Bags and Relined


  • Floors are clean

  • No build up in corners

  • Baseboards are Clean

  • Carpet free of debris and spots

  • No dust bunnies behind doors or equipment


  • Hallway Sinks Clean

  • Employee Signature when Available:

  • Manager conducting Audit


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.