Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Lobby Area
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Licenses are current and in the lobby area?
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Furniture is cleanable and non-porous?
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Furnishings are inviting to clients and visitors, clean and well maintained?
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Signage is professional, cleanable and up-to-date?
Breakrooms and Kitchenettes
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Comments
Bathrooms
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Toilets are free from stains?
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Toilet caulking is in good condition and free from stains?
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All items in bathroom are safe and secured, no ligature points?
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Floor corners are clean and free of debris?
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Restroom is free from mold and soap scum build up?
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Vents are clean?
Maintenance/Custodial Rooms
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Mops and brooms are stored appropriately?
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Sink and counters are clean from stains and dirt?
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Items are put on shelves and organized?
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Floor is clean from debris?
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Electrical panels are not blocked, 3 feet of clearance?
Staff Station
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Staff Station is clean and free from hazards?
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Staff Station furniture is in good repair and clean?
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Area has items that can be used as a weapon?
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Staff personal items are stored appropriately?
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Office area has no identified concerns?
Office Areas
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Staff offices are free from any identified safety risks? Such as extension cords, fire hazards, unsafe items, water damage risks, ceiling tile stains, tripping hazards.
- Safe
- At Risk
- N/A
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Chair mats are in good condition?
- Good
- Fair
- Poor
- N/A
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Task chairs are in good condition?
- Good
- Fair
- Poor
- N/A
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No unapproved electrical items in offices?
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Offices are clean, orderly and professional in appearance?
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Office has personal furniture in use? Cleanable non porous?
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Toys in office area that need a cleaning log?
Staff Storage Area
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Staff storage areas are free from clutter?
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First Aid/PPE-Medical
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First aid kit current? PPE kit has adequate supplies?
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Medical/Emergency equipment up-to-date and calibrated?
Safety and Security
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No chemicals found in area of client care?
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No identified ligature risks in client areas?
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Interior/Exterior doors latch and secure appropriately?
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All exposed work areas are free from hazards to clients?
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Signage in building is appropriate, cleanable and professional?
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Keys and scan cards are maintained appropriately? Secure, identified and accounted for?
Fire Safety
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Fire Extinguishers are unobstructed
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Pull stations are unobstructed?
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Electrical items are approved and tagged?
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Fire Riser sprinkler system does not have items stored in front of it?
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Extension cords are not being used?
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Fire doors close and latch with no obstructions?
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Fire sprinkler heads are clean. the escutcheons are secure. No obstructions 18" clearance from ceiling?
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All exit doors unobstructed?
Exterior
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Landscaping is well maintained? Parking lot is in good condition? Parking lot is well striped? Grass is green and well trimmed?
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Emergency shutoff signs on Gas meter?
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Area is free of garbage?
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Dumpsters have a closing lid free of cracks?
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Dumpster area is free of garbage on ground?
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Parking lot is safe, no pot holes, large cracks or raised areas?
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Weeds are pulled?
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Dead bushes are pulled?
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Fences are in good repair, no holes, not leaning and slats are in good condition?
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Fire connections intact?
Identified Risks for Mitigation
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Risks that need future mitigation
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Capital Budget Items
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Bookcase needed?
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Desks needed?
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Common room furniture needed?
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Side chairs needed?
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Task chairs needed?
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Other items needed?
Comments
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Comments for Custodial Staff
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Comments for Maintenance Staff
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Comments for Maintenance Supervisor
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Comments for Purchasing
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Comments for Environmental Coordinator
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Comments for Property Management Coordinator
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Comments for Program Manger/Director/VP
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Exterior Comments
Overall
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