Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Total Number of Observation

  • Total Number Meeting the Standard

Case Management/Social Worker (street Clothes with Lab coat)

  • # Observed

  • # Meeting Standard

EVS (maroon shirt/navy pants)

  • # Observed

  • # Meeting Standard

Food Service (light grey/black pants)

  • # Observed

  • # Meeting Standard

Facility Services (Navy Pants/light blue shirt)

  • # Observed

  • # Meeting Standard

Laboratory-Phlebotomist

  • # Observed

  • # Meeting Standard

Nursing Assistant (black scrubs)

  • # Observed

  • # Meeting Standard

Nursing RN/LPN (royal blue and/or white scrubs)

  • # Observed

  • # Meeting Standard

Pharmacy Tech

  • # Observed

  • # Meeting Standard

Physical Medicine

  • # Observed

  • # Meeting Standard

Physician

  • # Observed

  • # Meeting Standard

Radiology (navy blue)

  • # Observed

  • # Meeting Standard

Resident or Intern

  • # Observed

  • # Meeting Standard

Respiratory Therapy (green)

  • # Observed

  • # Meeting Standard

Transporter (black shirt/Khaki pants)

  • # Observed

  • # Meeting Standard

Comments

  • Comments:

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.