• Organization

  • Building/Floor/Area

  • Unit

  • Manager

  • Unit Representative on tour

  • Vice President

  • Conducted on

  • Prepared by

  • Personnel on Tour

Previous Audits

  • Has the last Audit been reviewed?

  • Have all outstanding concerns been addressed?

  • Tap to enter information
  • Identify outstanding concerns.

Emergency Managment

  • Do Staff know the department specific response in the event of an emergency?

Fire Safety

  • Are exit doors and stairwells clear? Main corridor and stair exits can not be blocked by and means.

  • Are exit doors clearly marked exit and sufficiently illuminated? Check for burned out bulbs.

  • Do fire/smoke doors close freely and latch properly? Close the fire doors to see if they latch and see that there is no gap greater than 1/8 inch in the middle. (Smoke Barrier Doors may not had latch mechanism)

  • Are corridors and passageways free of obstructions? Crash carts and in -use isolation carets are permissible in the corridor. Patient care equipment that is in use is permitted in the corridor.

  • Are pull stations and fire extinguishers unobstructed? Are the fire extinguishers clearly marked? There must be nothing to obstruct access.

  • Are doors not propped/held open?

  • Are all materials stored a minimum of 18 inches fro the sprinkler deflectors? The distance between the sprinkler deflector and stored items is 18" for sprinkled buildings.

  • Fire protection equipment inspection tag is current and shows inspection (format mm/dd/yr). (Extinguishers monthly)

  • Sprinkler heads are free of foreign material. Are sprinkler escutions properly installed?

Hazardous Material and Waste

  • Are Emergency eyewashes and/or showers installed and maintained in accordance with ANSI Standard Z358.1 where there is reasonable potential exposure to injurious corrosive material? Eye wash bottles are not permitted.<br>

  • Are hazardous chemicals stored properly with entrance to area labeled properly? (NFPA Diamond) Are secondary chemical containers labeled with product name, hazard label and manufacturer? Indicate any chemical that is in a container other than the original container.

  • Are employees aware of how to access SDSs? Departmental Chemical Inventory List is available.

Infection Control

  • Is Personal Protective Equipment (PPE) available and worn when necessary?<br>

  • Is cleanliness maintained throughout the area?<br>

  • Is clean linen covered? <br>

  • Is clean linen kept separated from the dirty linen?<br>

  • Are refrigerator logs maintained and up to date? Are medications specimens and food kept in separate refrigerators?<br>

  • Are there any expired hand sanitizer dispensers or bottles?<br>

  • No food or drink in clinical work area. <br>

  • No boxes or clean equipment is on floor in clean storerooms. No corrugated boxes with outside shipping labels permissible in clean storerooms. <br>

  • HVAC vents free of dust<br>

  • Ice machines clean, no scale or growth on dispensing chutes or tubes.<br>

  • Is upholstered furniture/mattresses in good condition? (No tears, rips or exposed padding)<br>


  • Extension cords are not substituted for permanent wiring. (Only approved surge power strips)<br>

  • Equipment is clean and free from damage. Equipment is free of frayed wires and/or faulty plugs. (No tape or adhesive residue)<br>

  • Carts are clean and free of rust.<br>

  • Staff is surveyed for recurring equipment problems.<br>

  • Rechargeable equipment is plugged into a receptacle.<br>

  • Equipment is being routinely inspected as indicated by the Equipment Management Plan.

Safety Management

  • Is area free from evidence of smoking?<br>

  • Are there no damaged building materials (e.g. ceilings, caulking, corner casing, cove base, door floor tile, wall penetrations, painting needed, exposed wires)<br>

  • Are ceiling tiles free of cracks and holes, clean, stain free, and in good condition? Indicate where these bad tiles are located in the comments.<br>

  • Are compressed gases stored properly (partial/empty separated from full) and is proper signage indicating oxygen storage in place? Compressed gases need to be chained to the wall or on a cart secured. Freestanding bottles are not allowed. <br>

  • Medical gas shut-off valves are unobstructed and labeled to indicate the area served.<br>

  • No unauthorized appliances in the area (e.g. fans, unapproved heaters, toasters, toaster ovens).<br>

  • Nurse call pull cords in patient accessible bathrooms are appropriate length and accessible. Not knotted, tied, braided, or cut. <br>


  • Is staff's personal items properly secured? Check for purses, billfolds, money, keys, etc left out for you to take.<br>

  • Are all employees wearing their ID badges in plain view? <br>

  • Access control devices are in use and working properly. No codes written on or near doors.<br>

Staff Knowledge

  • Do staff know how to report a Security Incident, Safety Incident, Chemical Spill, Fire? <br>

  • Staff knows who can shut of medical gasses in an emergency. The RN, respiratory therapist in charge, or manager/supervisor in charge of area has the responsibility and authority to direct the shut-off of a medical oxygen gas valve in any life threatening situation. <br>


  • Are all mechanical rooms, electrical closets/panels, janitorial and communications rooms locked, clean and with no storage? Indicate which rooms are not clean that are itemized here.<br>

  • All junction boxes/switch plates are covered.<br>


  • Is there any additional findings?

  • Tap to enter information
  • Additionally findings 1:

  • Is there any additional findings?

  • Tap to enter information
  • Additionally findings 2:

  • Is there any additional findings?

  • Tap to enter information
  • Additionally findings 3:

EC Tour Complete

  • Is the EC Tour Complete?<br>


  • Department/Unit Representative

  • EOC Staff member leading tour

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.