Information
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Document No.
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Audit Title
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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
Location
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Center
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Room
Previous Inspection
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Has the last inspection been reviewed?
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Are there any out standing actions?
Room
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Carpet Condition
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Tile Condition
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Covebase/Baseboard Condition
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Area Rug Condition
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Heat/Cooling System Condition - Record Temperature
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Equipment/Furniture Condition
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Lighting
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Emergency Lighting Condition (Flashlight)
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Condition of Walls
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Condition of Ceilings/Vents/Air Return
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Conditions of Door
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Condition of Fire Extinguisher
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Condition of Carbon Monoxide Detector
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Condition of Sink - Record Water Temperture
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Bubbler/Water Cooler Condition
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Diapering Table - Record Water Temperature
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Condition of Windows
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Condition of Blinds / Shades
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Condition of Storage Units
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Condition of Exit Signs
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Locked Cabinet
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Outlet Cover Condition
Bathroom
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Tile Condition
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Covebase/Baseboard Condition
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Condition of Walls
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Lighting
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Condition of Ceilings/Vents/Air Return
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Conditions of Door
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Condition of Sink - Record Water Temperture
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Condition of Toilet/Urinal
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Bathroom Daily Check List Updated?
Sign Off
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Maintenance Tech Signture
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Inspector Signature