Milton Keynes Hospital

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

INTERNAL ELEMENTS

• Are the following internal elements free from defects or damage?

• Flooring

  Yes

  No

  N/A

• Frame

  Yes

  No

  N/A

• Walls

  Yes

  No

  N/A

• Ceilings

  Yes

  No

  N/A

• Joinery

  Yes

  No

  N/A

• Paintwork/Finishes

  Yes

  No

  N/A

• Other - give details

  Yes

  No

  N/A

Defective or damaged internal elements.

Internal Defect

• Is this a H&S or Infection Control Issue?

  Safe

  At Risk

  N/A

GENERAL SERVICES

• Are the following general services free from defects or damage?

• Plumbing

  Yes

  No

  N/A

• Electrical

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Defective or damaged general services.

Internal Defect

• Is this a H&S or Infection Control Issue?

  Safe

  At Risk

  N/A

MECHANICAL SERVICES

• Are the following mechanical services free from defects or damage?

• Air conditioning

  Yes

  No

  N/A

• Lifts

  Yes

  No

  N/A

• Gantry installations

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Defective or damaged mechanical services.

Internal Defect

• Is this a H&S or Infection Control Issue?

  Safe

  At Risk

  N/A

ESSENTIAL SERVICES

• Are the following essential services free from defects or damage?

• Sprinklers

  Yes

  No

  N/A

• Hose Reels

  Yes

  No

  N/A

• Hydrants

  Yes

  No

  N/A

• Extinguishers

  Yes

  No

  N/A

• Exit signs and lighting

  Yes

  No

  N/A

• Fire Doors

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

defective or damaged essential services.

Internal Defect

• Is this a H&S or Infection Control Issue?

  Safe

  At Risk

  N/A

EXTERNAL ELEMENTS

• Are the following elements free from defects or damage?

• Walls

  Yes

  No

  N/A

• Roofing

  Yes

  No

  N/A

• Access and doorways

  Yes

  No

  N/A

• Joinery

  Yes

  No

  N/A

• Glazing

  Yes

  No

  N/A

• Paintwork/Finishes

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Defective or damaged external elements.

Internal Defect

• Is this a H&S or Infection Control Issue?

  Safe

  At Risk

  N/A

GENERAL COMMENTS AND OBSERVATIONS

• Comments & Observations

• Date Audit Completed

  Date

• Auditor

  Sign