Title Page

  • Conducted on

  • Prepared by

  • Location

First impressions

  • Did you feel welcome?

  • Was the environment odourless/pleasant smelling?

  • Did the environment appear calm and well organised?

  • Did the area look clean?

  • Are staff interacting with residents/?

  • Did the work space look tidy?

Cleanliness and Infection Control

  • Are there housekeeping records in place?

  • Has the home bee cleaned at appropriate times?

  • Are staff wearing appropriate clothing (Name badges)

  • Are there gloves available for staff?

  • Are there handwashing signs in place?

  • Are there handwashing materials available?

  • Are there paper towels in the staff toilet?

  • Look in 3 rooms. room 1 of 3. document room number:

  • Is the room clean and tidy?

  • Is there fresh drinking water in reach of the resident/patient?

  • Look in 3 rooms. room 2 of 3. document room number:

  • Is the room clean and tidy?

  • Is there fresh drinking water in reach of the resident/patient?

  • Look in 3 rooms. room 3 of 3. Document room number:

  • Is the room clean and tidy?

  • Is there fresh drinking water in reach of the resident/patient?

Safety and Suitability of premises and equipment

  • Does the notice board look tidy with clear up to date information?

  • Are there any environmental issues that could lead to harm?

  • Are audits complete and accessible?

  • Are the fire exits clear of obstacles?

  • Is there any damaged equipment/broken furniture?

  • has this been reported?

Resident/patient feedback

  • Do you feel the food menus are personal and balanced?

  • Do you feel staff have a good attitude to working and engage with residents/patients?

  • Are there activities offered to residents/patients and are they person centred?

  • Do you know who to contact, or how to raise any concerns, ie safeguards or complaints?

  • Do you feel you are treated with dignity and respect?

  • Do you feel safe?

  • Is there anything else you wish to discuss, or any other feedback to add?

Staff feedback

  • Do you feel safe at work today?

  • Are there any staffing issues?

  • Is your mandatory training up to date?

  • Have you had supervision within the last month?

  • Do you know how to raise a safeguarding concern?

  • Is there anything else you wish to discuss, or any other feedback to add?

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.