• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Clean and dust free

  • Functioning properly (opening and closing)

  • Not chipped or cracked

  • Is the fire evacuation clear and visible


  • Clean and dust free

  • Two hangers and one pair of sleepers available

  • Functioning properly (opening and closing)

  • Not chipped or cracked

Patient bed

  • Clean and dust free

  • Bed is functionally properly to control

  • Nurse call bell working

  • Hand rub is awailable at bed side

  • Clean linen was provided

Attendant couch

  • Clean and dust free

  • Upholstery intact


  • Clean and dust free

  • Working & fixed properly


  • Clean and dust free

  • Pasted properly

Window glass

  • Clean and smudge free

  • Window not cracked

  • Frames fixed properly

  • Properly filmed

Walls and ceiling

  • Clean and stain free

  • No cracks on wall and ceilling

  • Painted well

  • Is the smoke detector working appropriately

  • Is Fire sprinkler is without obstructions


  • Outlet Grill Clean and dust free

  • Thermostat working properly


  • TV remote is working

  • TV signals are clear


  • Mirror is stain less

  • Shower curtain is clean

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.