• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Location, Time and Date

  • Location of Rounds

  • Time & Date


  • Are doors locked?

  • Add media

  • Are all windows shut?

  • Intrusion Alarm Active?

  • Add media

  • Are lights off?

  • Add media

  • Areas safe and free from identified hazards that can injure staff, patients and/or visitors?

  • Add media

  • Building and Grounds area free from Maintenance Issues or Repairs needed?

  • If no, was a work order submitted?

  • Add media

Completed By

  • Signature of Officer Conducting Rounds

  • Printed Name

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.