• Audit Title

  • Document No.

  • Select date

  • Prepared by:

  • Manager Director

  • Location
  • Please Note: This Information Is Reported To The Director And Manager For Corrective Action For Clinical Issues Only. All Facility Related Issues Will Be Entered Into Archibus via Safety Operations.


  • 002. Are exit signs readily visible and illuminated?

  • 003. Smoke barrier doors have proper gaps (1/8" max opening between doors and 1/4" from door to floor)?

  • 004. Are smoke barrier doors self closing/automatic?

  • 005. Are windows in smoke doors or walls made of fixed wire glass?

  • 007. There are no voids in fire or smoke barriers?

  • 008. Are fire doors free of damage and do they close properly? There are no doors propped or wedged open.

  • 010. Are pull stations visible?

  • 011. Are fire extinguishers properly charged?

  • 012. Does fire extinguisher inspection tag indicate extinguishers are being inspected monthly?

  • 013. Are fire extinguishers accessible?

  • 014. Are emergency evacuation route signs current?

  • 017. Are the No Smoking rules followed?

  • 020. Are there at least two posted emergency exits on each unit or floor?

  • 701. Is lab safety sign information up to date?

  • 702. Do aisles have sufficient width for passing?

  • 703. Is food stored properly, not in refrigerators or cabinet used to store lab samples or chemicals?

  • 704. Exit doors and corridors unobstructed?

  • 705. Non-explosive proof refrigerator/freezers are posted with sign to warn people not to store flammable liquids in this equipment?

  • 706. Doors are not blocked or wedged open?

Hazardous Materials

  • 301. Is the hazardous chemical inventory current?

  • 302. Staff know how to retrieve SDS (MSDS)?

  • 303. Are all chemicals properly labeled?

  • 304. Are stored chemicals properly secured?

  • 307. Are waist/used chemicals disposed of properly?

  • 308. Are chemicals stored in the proper storage cabinets according to their compatibility?

  • 309. Are emergency eyewash stations and safety showers available in required areas?

  • 310. Are plumbed emergency eyewash station tested weekly?

  • 311. Solids stored above and liquids below?

  • 312. Flammable liquids are stored in an NFPA approved cabinet with a self closing door?

  • 313. Peroxideable and/or shock sensitive compounds are properly stored and labeled with last date opened?

  • 314. Gas cylinders in an upright position?

  • 315. Are protective caps in place over the value of all gas cylinders which are not in use?

  • 316. Respirators used? Necessary? Correct procedure followed?

  • 317. Fume hoods and Biological Safety Cabinets tested within the last year?

  • 318. Access to appropriate eye protection including face shields, gloves, and other PPE?

  • 319. Proper lab attire including: no shorts, sandals, or open toe shoes, and no loose hair or clothing.

  • 320. Shelves are not overloaded, crowed, have excessive weight on shelves, or are inadequate?

  • 322. There are no combustible metals being used liked lithium, magnesium, or sodium?

Storage, Housekeeping, & Supplies

  • 402. Are refrigerators clean?

  • 403. Are refrigerator temperature logs current?

  • 405. Is food consumption, including drinking, prohibited in patient care areas?

  • 406. Is infectious waist disposed of properly?

  • 407. Are chemicals, medications, and/or supplies current and do not have expired dates?

  • 409. Are sterile items stored/high level disinfectants items stored at least 10" off the floor, 6" from outside walls, and 18" from ceiling fixtures?

  • 411. Sharps containers not overfilled above the 3/4 full mark?

  • 418. Laboratory work and storage areas are clean, orderly, and free of clutter?

  • 419. Supplies stored within arms reach without the use of a ladder?

  • 420. Is broken glass disposed of properly? Is the condition of the broken glass box adequate?

  • 421. Are they any sinks or floor drains that are infrequently used?

  • 422. Adequate hand washing facilities?

  • 423. Are boxes, equipment, ect, not being stored on floor to allow/provide for floor cleaning?

  • 424. A UL listed waste can is available where solvent soaked rags are used?

Compressed Gases

  • 801. Gas cylinders are secured in an upright position?

  • 802. Cylinders capped when not in use?

  • 803. Main valve closed and pressure in regulator released when cylinder not in use?

  • 804. Flammable gas storage limited to those tanks currently in use and 1 spare?


  • 201. Are fluorescents lights equipped with working bulbs?

  • 202. Do emergency lights work properly in areas provided?

  • 205. Is electrical equipment and wiring undamaged?

  • 206. There are no portal space heaters in the area?

  • 207. Extension cords are not used (Exception: Emergency and/or single not ganged fused circuit breaker bars)?

  • 212. No usage of three way plugs?

  • 213. Equipment is grounded properly?

  • 214. All electrical panels and breaker boxes have a clear area of 3 feet?

  • 217. Are all heat producing devices (toaster, coffee pots, etc.) unplugged when not in use?

  • 107. Are inspections on equipment being completed in a timely manner.

Safety Management

  • 401. Refrigerators used for specimens, medications, chemicals ect. Are free of food?

  • 402. Are refrigerators clean?

  • 403. Are refrigerators temperature logs current?

  • 404. Are specimens and/or medications stored in a separate refrigerators? In patient care areas, a separate refrigerator is used for each of the following: unit medications, patient food, staff food, and patient specimens?

  • 405. Is food consumption, including drinking, prohibited in lab/patient areas?

  • 406. Is infectious waste disposed of properly?

  • 408. Are sterile and clean supplies stored separately?

  • 414. There are no damaged floor tiles, torn carpet, or trip hazards?

  • 415. There are no damaged/missing ceiling tiles?

  • 501. Is there an emergency procedures posted and current?

  • 503. The fire alarm location page and other emergency announcements in buildings which voice annunciation are clearly audible in this area?


  • 601. Are valuables secured (purse, expensive equipment, ect.)?

  • 604. Are fax machines in non-public areas to protect confidential information?

  • 605. Are copy machine in non-public areas to protect confidential information (if in public areas copies are not left in machine)?

  • 606. Research information is not visible from public areas?

  • 607. Lab area is secured when not occupied?

  • 608. Staff is trained to question unknown individuals and report suspicious activity behavior?

  • 609. Hazardous material is secured?

  • 610. Name tags available or being worn?


  • 999. No other deficiencies or areas of concern were noted?

If the following question is answered Yes, information must be forwarded to the institutional Biosafety Officer

  • Are you using any recombinant DNA and/or other biohazardous agent in your laboratory? (Most common: for bacteria, E. Coil, K12, for virus Andeno-associated virus, Replication deficient adenovirus.)

  • 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.