Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Location

  • Center

  • Room

Previous Inspection

  • Has the last inspection been reviewed?

  • Are there any out standing actions?

Room

  • Carpet Condition

  • Tile Condition

  • Covebase/Baseboard Condition

  • Area Rug Condition

  • Heat/Cooling System Condition - Record Temperature

  • Equipment/Furniture Condition

  • Lighting

  • Emergency Lighting Condition (Flashlight)

  • Condition of Walls

  • Condition of Ceilings/Vents/Air Return

  • Conditions of Door

  • Condition of Fire Extinguisher

  • Condition of Carbon Monoxide Detector

  • Condition of Sink - Record Water Temperture

  • Bubbler/Water Cooler Condition

  • Diapering Table - Record Water Temperature

  • Condition of Windows

  • Condition of Blinds / Shades

  • Condition of Storage Units

  • Condition of Exit Signs

  • Locked Cabinet

  • Outlet Cover Condition

Bathroom

  • Tile Condition

  • Covebase/Baseboard Condition

  • Condition of Walls

  • Lighting

  • Condition of Ceilings/Vents/Air Return

  • Conditions of Door

  • Condition of Sink - Record Water Temperture

  • Condition of Toilet/Urinal

  • Bathroom Daily Check List Updated?

Sign Off

  • Maintenance Tech Signture

  • Inspector Signature

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.