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
Room 101
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 102
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 103
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 104
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 105
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 106
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 107
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 108
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 109
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 110
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 111
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 201
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 202
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 203
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 204
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 205
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 206
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 207
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 208
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 209
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 210
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 211
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
Room 212
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
ER Room 1
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
ER Room 2
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
ER Room 3
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
ER Room 4
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
OR Pre-op Room 1
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
OR Pre-op Room2
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
OR Post-op Room 1
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
OR Post-op Room 2
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
OR Post-op Room 3
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Check GFCI for proper operation.
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Check for proper ground tension.
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Check for loose covers.
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Check for loose outlets.
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Check for proper voltage.
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Add signature
