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

  Good

  Fair

  Poor

  N/A

• Internal doors and frames

  Good

  Fair

  Poor

  N/A

• Walls and other structural elements

  Good

  Fair

  Poor

  N/A

• Ceilings

  Good

  Fair

  Poor

  N/A

• Joinery

  Good

  Fair

  Poor

  N/A

• Paintwork/Finishes

  Good

  Fair

  Poor

  N/A

• Other - give details

  Good

  Fair

  Poor

  N/A

GENERAL SERVICES

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

• Plumbing

  Good

  Fair

  Poor

  N/A

• Electrical

  Good

  Fair

  Poor

  N/A

• Other

  Good

  Fair

  Poor

  N/A

MECHANICAL SERVICES

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

• Air conditioning

  Good

  Fair

  Poor

  N/A

• Lifts

  Good

  Fair

  Poor

  N/A

• Gantry installations

  Good

  Fair

  Poor

  N/A

• Other

  Good

  Fair

  Poor

  N/A

ESSENTIAL SERVICES

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

• Sprinklers

  Good

  Fair

  Poor

  N/A

• Hose Reels

  Good

  Fair

  Poor

  N/A

• Hydrants

  Good

  Fair

  Poor

  N/A

• Extinguishers

  Good

  Fair

  Poor

  N/A

• Exit signs and lighting

  Good

  Fair

  Poor

  N/A

• Fire Doors

  Good

  Fair

  Poor

  N/A

• Other

  Good

  Fair

  Poor

  N/A

EXTERNAL ELEMENTS

• Are the following elements free from defects or damage?

• Walls

  Good

  Fair

  Poor

  N/A

• Roofing

  Good

  Fair

  Poor

  N/A

• Access and doorways

  Good

  Fair

  Poor

  N/A

• Joinery

  Good

  Fair

  Poor

  N/A

• Glazing

  Good

  Fair

  Poor

  N/A

• Paintwork/Finishes

  Good

  Fair

  Poor

  N/A

• Other

  Good

  Fair

  Poor

  N/A

GENERAL COMMENTS AND OBSERVATIONS

• Comments & Observations

• Date Audit Completed

  Date

• Auditor

  Sign