Audit

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Area

Responsible Manager

Initiator

Notification

Findings

Water Present

Water Damage present (Stain)

Suspected Fungal Growth - Exposed

Suspected Fungal Growth - Encapsulated

Wall Damage

Floor Damage

Ceiling Damage

Class 1 Containment

Action Plan

Class 1 Containment

Class 2 Containment

Class 3 Containment

Severity

Infection Prevention Permit Required

Midas Focus Study

Assessment Team Signatures

Safety Officer
Infection Preventionist
Facilities
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.