• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Hallways and stairs are free from obstructions?

  • Do the elevator doors open close properly?

  • Are the walls and ceilings free of major damage and stains?

  • Do the floors have damaged carpet or tile, slippery spots, or tripping hazards?

  • Are the ventilation grills clean and unobstructed?

  • Are the handrails present and secure in the patient rooms, bathrooms, and stairwells?

  • Are the crash carts inspected and up to date?


  • Have the fire extinguishers been inspected monthly?

  • Are the fire extinguishers and pull stations easily accessible?

  • Are the EXIT lights unobstructed and lit?

  • Do the self closing doors close all the way and latch?


  • Only hospital approved extension cords are in use and are not a trip hazard, or untidy?

  • The outside of equipment and the power cords / plug have no visible damage?

  • Are the utility panels free from obstructions?

  • Are the electrical outlets free from damage?

  • Is the medical equipment properly tagged and PM'd within the last (12) twelve months?

  • Are the medical gas valves properly labeled and functioning?


  • Are supplies properly stored and has an 18 inches of clearance under the sprinkler heads?

  • Boxes and supplies are kept at least 6 inches off of the floor?

  • The bottom shelf of carts have a liner to prevent splashing onto the supplies or equipment?

  • The gas cylinders are secured in carts, stands, or chained to the wall?


  • The electrical closets, data closets, and hazardous areas are kept locked?

  • Personal items (purses, wallets, keys, etc.) are stored and kept out of sight?

  • Are employees wearing their photo identification badges, facing forward at chest level?

  • Doors with extra security devices (such as card readers or keypads) are always allowed to close and lock?


  • Are the isolation rooms properly labeled, functioning, with supplies readily available outside of the door of the isolation patient

  • Is the department clean and dust free?

  • Are the SHARPS containers less than 2/3 rds full and secured to the wall, cabinet, or cart?

  • Is there evidence of hand hygiene practiced and witnessed in the work or clinical area? ( ) out of ( ) observed.

  • Is the medication preparation area clean and unobstructed with signage visible?

  • Are sinks clear of clutter or supplies at least 12 inches?

  • Are patient refrigerators clean and all contents within the manufactures expiration date?

  • Are staff refrigerators clean and all contents within the manufactures expiration date?

  • Are the microwave ovens clean?

  • Is personal protective equipment readily available where and when appropriate?

  • Is there any evidence of storage under the sinks?



  • Add 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.