Title Page

  • Site conducted

  • Conducted on

  • Prepared by

Audit Questionnaire

  • Is door 1 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 3 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 5 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 7 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 9 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 11 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 13 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 15 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 17 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 19 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 21 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 23 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 25 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 27 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 29 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B1 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B2 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B3 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B4 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B5 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B6 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door B7 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 28 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 26 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 24 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 22 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 20 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 18 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 16 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 14 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 12 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 10 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel at OCC clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 8 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is electric panel clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door 6 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 4 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door 2 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is main electric panel in maintenance clear of all obstructions, debris, etc. within 36 inches in all directions?

  • Is door A6 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door A5 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door A4 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door A3 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door A2 clear of all obstruction, debris, etc. within 36 inches in all directions?

  • Is door A1 clear of all obstruction, debris, etc. within 36 inches in all directions?

Safety Concerns

  • Where there any other safety concerns discovered during this walk? Water on floor, spill, etc?

Door Security

  • Where any doors discovered to be unsecure (open) during this audit?

Conclusion

  • Anything else to add regarding this audit?

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