Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 - Previous inspection

  • 1.1 - Has the last inspection been reviewed?

  • 1.2 - Are there no outstanding actions?

2.0 - Room Condition

  • 2.1 - Carpet Condition

  • 2.2 - Tile Condition

  • 2.3 - Covebase/Baseboard Condition

  • 2.4 - Area Rug Condition

  • 2.5 - Heat/Cooling System Condition - Record Temperature:

  • 2.6 Equipment Condition

  • 2.7 - Lighting Condition

  • 2.8 - Emergency Lighting Condition

  • 2.9 - Condition of Walls

  • 2.10 - Condition of Ceilings/Vents/Air Return Duct

  • 2.11 - Condition of Doors

  • 2.12 - Condition of Fire Extinguisher

  • 2.13 - Condition of Carbon Monoxide Detectors

  • 2.14 - Condition of Sink - Record Water Temperture

  • 2.15 - Bubbler/Water Cooler Condition

  • 2.16 - Diapering Table - Record Water Temperature

  • 2.17 - Condition of Windows

  • 2.18 Condition of Blinds / Shades

  • 2.19 - Condition of Storage Cabinets

  • 2.20 - Condition of Shelving Units

  • 2.21 - Condition of Exit Signs

  • 2.22 - Locked Cabinet

  • 2.23 - Outlet Cover Condition

  • 2.25 - Is Preventive Maintenance Checklist Updated? (Check with Center Director)

3.0 - Bathroom

  • 3.1 - Tile Condition

  • 3.2 - Covebase/Baseboard Condition

  • 3.3 - Condition of Walls

  • 3.4 - Lighting Condition

  • 3.5 - Condition of Ceilings/Vents/Air ReturnDuct

  • 3.6 - Condition of Doors

  • 3.7 - Condition of Sink - Record Water Temperature

  • 3.8 - Condition of Toilet/Urinal

  • 3.9 - Bathroom Daily Check List Updated?

Sign Off

  • Center Director

  • Inspector's Signature

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