Title Page

  • Conducted on

  • Prepared by

  • Location


Devices (computers, printers, iPads, etc)

  • Are devices in good working order?

  • If any device is less than in GOOD working order, record details.

  • Are devices free of visual damage?

  • If any device has any damage, record details.

  • Are passwords stored on devices in a manner that allows others to use access to secured passwords (on sticky notes, etc.)

  • If yes, record details.

  • Do devices match Asset Guard information?

  • If no, record details.

  • Has all information been updated in Asset Guard for this date’s inspection?

  • If no, record details.

  • Are devices stored in a secure location when not in use?

  • Record details. Include storage location and if location is locked?

  • Do all devices have chargers?

  • If no, record details.

  • Do all devices hold a charge adequately?

  • If no, record details.

  • Are there any other needs for devices that should be followed up?

  • If yes, what needs are being addressed?

  • Do any employees leave the facility at any time with devices?

  • If yes, does this employee have written approval to remove device from facility? (Attach documentation)

Physical Assesment

  • Are all rehabilitation department areas secure when not in use?

  • How are areas secured?

  • Is there printed or written PHI in the department areas?

  • If yes, describe what manner of PHI?

  • Is printed or written PHI the minimum necessary to fulfill job requirements?

  • If no, record details.

  • Is PHI secured properly?

  • If no, record details.

  • Do any employees leave the facility at any time with written or printed PHI?

  • If yes, record details.

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.