• Document No.

  • Site:

  • Type of Audit:

  • Reason for Audit

  • Reason for Audit

  • Conducted on

  • Conducted By:

  • Any relevant Information

Resident 1

  • Resident Name:

  • Date of Birth:

  • Room Number:

  • Admission Date:


  • Is there a photo ID card/divider between Residents MAR?

  • Is there a photo ID card/divider between Residents Medication Stored in Racks / Dispensers?

  • Is the Allergy Status recorded on the photo ID card / MAR or Other easily identified area when Administering Medication?

  • Is the persons name clearly identified on the Pharmacy Issued MAR and Pharmacy Medication Labels?

  • Is the persons name clearly identified on all Handwritten MAR?


  • Record All Medications Resident is currently Prescribed for:

  • Are dates and quantities of Medications received, recorded on the Pharmacy MAR?

  • Are they 'Initialed'

  • Are 'Carried Forward' quantities recorded on the MAR?

  • Are they 'Initialed'

  • Is there an appropriate code or signature for all doses administered?

  • Are dosage times written in the appropriate places and easily identified?

  • If 'Colour Coding' is used, is it Consistent?

  • Are variable doses required?

  • Are they recorded correctly?

  • Are there any 'HANDWRITTEN' Sheets?

  • Are all Medications written exactly the same as the label?

  • Is the Handwriting 'Legible'?

  • Are there two Signatures for the entry?

  • Does the Label and MAR include any special instructions? ( With food, take with a full glass of water)

  • Do the medicines administered tally with the remaining medicines?

  • Record which Medications do not 'Tally':

  • Is the administration of all topical preparations recorded?


  • Is the Resident taking any controlled drugs at this time?

  • Are the Residents CD's stored in a metal 'Locked' cupboard/cabinet?

  • Is the CD Register a 'Hard Bound Book' with numbered pages?

  • Are balances recorded correctly and countersigned with a second signature?

  • Do CD balances match current stock?

  • Are alterations or errors correctly entered?

  • Are CD's disposed of correctly when required? Check Log Sheets

  • Are there 2 signatures for all entries in the CD book?

  • Are Regular Stock Checks recorded? (Minimum weekly)

PRN MEDICATION - (As Required)

  • Is any Medication Prescribed as 'PRN'? (As Required)

  • Is there 'Proof' that the Medication is 'Offered'?

  • How is this Evidenced?

  • When Medication is 'Given' is the reason and quantity, Recorded Correctly?

Homely Remedies

  • Are any 'Homely Remedies' given to the Resident?

  • List the Products:

  • Are they given in accordance with 'Documented Approval'?

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.