• Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Previous inspection

  • Has the last inspection been reviewed?

  • Are there no outstanding actions?

Patient Safety

Are corridors kept clear to allow adequate space?

  • To allow ambulation of patients and visitors to walk safely?

  • To allow carts, wheelchairs and beds to pass with adequate clearance?

  • Are floors clear and slip-resistant?

Are medications secured and locked?

  • Are medication rooms and carts locked when not attended?

  • Are medications secured at all times?

Fire Safety

  • Are the means of egress/exit doors clearly and correctly marked?

  • Exit sign lights working?

  • Clear of debris and equipment?

  • Is equipment all to one side of the hall?

Do all identified fire extinguisher locations?

  • Is the location clearly marked?

  • Have current inspection tags?

  • Are safety seals present?

  • Have 3foot access clearance?

Are the fire alarm pull stations

  • Accessible with 3 foot clearance?

  • In good condition?

Are combustible materials: (paper,cardboard boxes,linen,waste)

  • Stored in proper type of containers?

  • Kept in minimum quantities necessary for daily use?

  • Properly labeled?

  • Kept in a safe designated location?

Fire Smoke Stair doors:

  • Are the doors free of being propped/held/wedged open?

  • Are doorways clear to close?

  • Do fire and stairwell doors latch firmly?

  • Are door interrupters working?

  • No door wedges present?

  • Are items stored at least 18" below sprinkler head?

  • Do patient privacy curtains have 18" net at the top?

  • Are portable space heaters present in patient sleeping areas?

  • No indication of s,oping in the area?

Safe Environment:

Are the floors / hallways (tile &carpet)

  • In good condition?

  • Clean and dry

  • Free from trip/slip/fall hazards?

  • Wet floor signs used

  • Carpet lying flat on floor?

  • There are no wires or cables across walkways?

Are the walls:

  • In good condition?

  • Any exposed wires/cables present?

  • Electrical boxes, outlets, covers in good condition?

Are ceiling tiles:

  • In place and in good condition?

  • Clean free of dirt, mold, and dust?

  • Free of evidence of water staining & dry?

Are safe / proper infection control practices used by staff?

  • Are needle boxes less than 75% full

  • Is clean linen covered?

  • Are clean and dirty linens kept separate?

  • Is medication labeled and dated? (Any outdated items found?)

  • Are refrigerators appropriately labeled?

  • Do refrigerators have current temp logs?

  • Are all cardboard boxes off the floor and no shipping boxes on the unit?

  • Are blood borne pathogen precautions in evidence? (Gloves,masks,gowns, separation of waste)

  • Is PPE readily available and in good condition?

  • Are the areas under the sink free of patient contact items?

  • Are compressed gases stored/ used in this area secured?

  • Is there less than 300 cu ft O2 stored in area? (12 E tanks)

Hazardous materials and waste:

  • Are hazardous chemicals used in this area?

  • Are they stored correctly?

  • Are they disposed of correctly? (Procedures followed)


  • Can staff explain how to look up an SDS?

  • Can staff describe what info is contained on SDS sheets?

  • Is there a chemical inventory list?

  • Has the list been updated within the past 12 months?

  • Can staff explain the locations of SDS master files?

Are medical wastes:

  • In red biohazard bags / labeled containers?

  • Is pharmaceutical waste in the proper containers?

  • Pharmaceutical waste is secured in the med room?

  • Properly stored and disposed of?

  • Properly separated and segregated?

Medical equipment

Is there medical equipment in use or used in this area?

  • Are inspection tags current?

  • Can staff explain if equipment is current?

  • Is equipment clean and stored properly?

  • Can staff describe training requirements for equipment?

  • Can staff explain emergency procedures for life support equipment?

Utility systems

Are emergency power outlets:

  • Clearly marked?

  • Used for critical equipment only?

Is there any exposed wiring or electrical panels?

  • Are breakers labeled?

  • Are panels kept locked?

  • Outlets, electrical box cover plates aren't damaged or missing?

Are medical gas zone valves and main valves:

  • Are valves marked with identity &locations served?

  • Is the valve access alb and not blocked?

  • Do staff understand who should shut oxygen valves in the case of a fire emergency?


  • Are all employees wearing ID badges in plain view?

  • Can staff explain how to get help in a security emergency?

  • Are protective measures in sensitive areas active & are staff able to explain their role in protecting the patients?

  • Can staff explain their role in a code pink? (If any)

Emergency operations plan

  • Can staff explain their role in the various emergency operations plan?


Sign Off

  • On site representative

  • Auditor's 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.