• Facility

  • Unit

  • Manager

  • Unit Representative on tour

  • Conducted on

  • Prepared by


  • Has the last audit been reviewed?

  • Have all outstanding concerns been addressed?

  • Tap to enter information
  • Identify outstanding concerns.


  • Hallways clear of clutter.

  • Exit doors unobstructed.

  • No propped doors.

  • Storage (boxes etc.) are stored no less than 18" from sprinkler head.

  • Storages (boxes etc.) are 6" above floor.

  • No cracked, stained, or missing ceiling tiles.

  • No codes written on access control doors.

  • Outlets covered and in good condition

  • All junction boxes are covered.

  • No damaged building materials (e.g. walls, floors, ceilings, furniture, furnishings)


  • Staff can identify Emergency Response<br>

  • Staff are wearing ID cards.

  • Employees know how to access SDSs, Chemical Inventory List available.

  • Personal items kept secured in work areas. (Handbags, Wallets)

  • Staff Code knows Code Red. What is RACE

  • Employees know the process for reporting a security incident, chemical spill, Code Red. (RACE)<br>

  • Staff knows who can shut off medical gases in an emergency.

  • Gas valves labeled and unobstructed

  • Staff demonstrates knowledge of Code Green Disaster response.

  • Personal Protective Equipment (PPE) available and worn when necessary.


  • Electrical closet/panels, mechanical closets, housekeeping closets are locked.

  • Fire extinguishers are clearly marked (signage). Checked monthly<br>

  • Fire extinguishers unobstructed. (3' clearance)

  • Exits illuminated; clearly and correctly marked.

  • Pull stations unobstructed (3' clear) and intact.

  • Smoke/Fire Doors close freely.

  • No smoking policy enforced (no visible signs of non-compliance).

  • Fire Tower Exits unlocked from floor (unless approved variance - special conditions).

  • Proper stair identification signage at landings.

  • Fire evacuation diagram signage posted at elevator call stations/landings.

  • Medical gas shut-off valves are labeled to indicate the area served.

  • Access control devices (card readers, combination locks) are in use and working properly.

  • Area is adequately lighted.

  • Sprinkler heads are free of foreign materials.

  • No unauthorized appliances (space heater, toaster).

  • Extension cords are not substituted for permanent wiring. (only approved surge power strips)

  • Entrances to areas storing hazardous chemicals are labeled properly.

  • Chemicals stored properly.

  • Gas cylinders properly secured.

  • Nurse call operates (random check)

  • Check eye wash station

  • Operating flashlight


  • Equipment is clean and free from damage.

  • Equipment is free of frayed wires and/or faulty plugs.

  • Users of equipment is surveyed for recurrent problems.

  • Rechargeable equipment is plugged in.

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

  • Crash carts checked and plugged into emergency outlet


  • Alcohol based hand washing solution readily available (staff handwashing).

  • Clean linen cart covered, no items stored on top.

  • No food or drink in clinical work area.

  • Refrigerator Monitored by Primex Wireless

  • Clean and dirty linen are separated and never stored together.

  • Standards of cleanliness are maintained throughout.

  • HVAC vents free of dust.


  • 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:


  • Department/Unit Representative

  • Auditor

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.