Title Page

  • Site conducted

  • Document No.

  • Audit Title

  • Conducted on

  • Prepared by

  • Location

Is this location a staffed club?

  • Select YES or NO

Employee Training

  • First Aid/AED certified employees available to assist in an emergency?

  • Explain correction to be made:

  • Is there an updated contact list at the Member Support desk?

  • Explain correction to be made:

  • Is the MOD schedule posted and accessible by all staff?

  • Explain correction to be made:

Ask 2 employees (other than front desk) where AED is located and what it is for.

  • Employee #1 name:

  • Employee #2 name:

  • Were all employees able to locate and describe purpose of AED?

  • Explain correction to be made:

SDS - Ask 3 employees from different departments what an SDS is and where the binder is located.

  • Employee #1 name:

  • Employee #2 name:

  • Employee #3 name:

  • Were all employees able to describe the purpose and location of the SDS?

  • Explain correction to be made:

Incident Reports/Property Loss - Ask 3 employees from different departments the purposes and processes for filing an incident report.

  • Employee #1 name:

  • Employee #2 name:

  • Employee #3 name:

  • Were all employees able to describe the different report forms and the processes for submitting them?

  • Explain correction to be made:

Emergency Procedures

Ask two staff members the where the emergency binder is, what its purpose is and what information it contains.

  • Employee #1 Name:

  • Employee #2 Name:

  • Were both employees able to identify the purpose, content and location of the emergency binder?

  • Explain correction to be made:

  • Are the emergency procedures in a red binder at the member support desk?

  • Explain correction to be made:

  • Photo of red emergency procedures binder

Ask 3 employees what they would do in case of a fire, earth quake, or if the lights went out.

  • Employee #1 name:

  • Employee #2 name:

  • Employee #3 name:

  • Were all employees able to describe the proper procedures in case of these events?

  • Explain correction to be made:

Ask two employees the hazards of two different chemicals.

  • Employee #1 name:

  • Two chemicals and their hazards:

  • Employee #2 name:

  • Two chemicals and their hazards:

  • Were both employees able to identify the hazards of the chemicals?

  • Explain correction to be made:

Biohazard - Ask two employees what the biohazard kit's purpose is and where it is located.

  • Employee #1 Name:

  • Employee #2 Name:

  • Were all employees able to identify the purpose of the biohazard kit and its location?

  • Explain correction to be made:

Emergency Procedures

  • Are the emergency procedures posted somewhere or in a red binder?

  • Explain correction to be made:

  • Photo of the red emergency procedures binder or posted info.

Fire

  • Emergency exit signs identifiable and readily visible?

  • Explain correction to be made:

  • Emergency lights working?

  • Explain correction to be made:

  • Water shut off valves accessible?

  • Explain correction to be made:

  • Is there an 18" vertical clearance maintained from sprinkler heads?

  • Explain correction to be made:

  • Fire alarm pull stations and fire extinguishers visible and unobstructed?

  • Explain correction to be made:

  • Fire extinguishers checked monthly for green & signed off?

  • Explain correction to be made:

  • Photo of one signed off extinguisher

  • Carbon monoxide detectors working?

  • Explain correction to be made:

  • Flammables stored in flammable lockers?

  • Explain correction to be made:

Earthquake

  • Bookcases, filing cabinets, shelves, racks, cages, storage cabinets, and similar items over four feet tall secured?

  • Explain correction to be made:

  • Large and heavy objects stored at waist level?

  • Explain correction to be made:

  • In case of power loss, are there working flashlights available in every department?

  • Explain correction to be made:

Electrical

  • Are electrical panels filled with breakers or metal blanks?

  • Explain correction to be made:

  • Are electrical panels unobstructed and easy to get to?

  • Explain correction to be made:

  • Photo of an Electrical Panel

  • Is there a diagram explaining what all fuses are for?

  • Explain correction to be made:

  • Do all tools, equipment, vacuums, extension cords, etc. have electrical cords in good condition with no frays, with grounding plug attached?

  • Explain correction to be made:

  • Do all lights have effective coverings?

  • Explain correction to be made:

Hazardous Materials

  • Are all secondary containers properly labeled per GHS requirements?

  • Explain correction to be made:

SDS

  • Is the SDS current and accurate?

  • Explain correction to be made:

Choose two different chemicals and confirm they have SDS sheets in the SDS.

  • Chemical #1

  • Chemical #1 SDS Sheet

  • Chemical #2

  • Chemical #2 SDS Sheet

  • Did both chemicals have an SDS sheet in the SDS binder?

  • Explain correction to be made:

Eye Wash Stations

  • Do all chemical storage or chemical mixing areas have eye wash stations?

  • Explain correction to be made:

  • Do your eye wash stations contain saline solutions?

  • Are the saline solutions expired?

  • Explain correction to be made:

Respirator Staff

  • Does your location require a respirator certified employee?

  • Do you currently have a respirator certified employee?

  • Picture of respirator certification.

  • Does your certified employee have all proper equipment onsite?

  • Explain correction to be made:

  • Explain correction to be made:

  • Does this location have a pool or hot tub WITH a pump room that mixes chemicals?

  • Is there PPE available in the pump rooms? (Apron, masks, eye protection, gloves, Etc.)

  • Explain correction to be made:

  • Is there adequate PPE in chemicals mixing/storage areas?

  • Explain correction to be made:

General Housekeeping

Are the following areas/items free of hazards, clean and maintained?

  • Storage Rooms?

  • Explain correction to be made:

  • Mechanical/Pump Rooms?

  • Explain correction to be made:

  • Maintenance Shops?

  • Explain correction to be made:

  • Building Exterior?

  • Explain correction to be made:

  • Offices?

  • Explain correction to be made:

  • Pool decks?

  • Explain correction to be made:

  • Water heaters/Boilers/Steamers/Etc.

  • Explain correction to be made:

  • Cardio/weight room floors clear of trip hazards (carpet strands, threshold joiners, Etc)

  • Explain correction to be made:

  • Outlet covers

  • Explain correction to be made:

  • HVAC Systems/Active Pure systems

  • Explain correction to be made:

  • HEPA filters

  • Explain correction to be made:

  • Guards on tools

  • Explain correction to be made:

  • Riser rooms

  • Explain correction to be made:

  • Laundry rooms/lint traps free of excess lint?

  • Explain correction to be made:

  • Fitness equipment

  • Explain correction to be made:

AED

  • AED condition:

  • Are the shock pads expired?

  • Battery condition:

  • Emergency/First Aid Kit Updated?

  • Is the Emergency Procedure Red Binder Updated?

  • Explain correction to be made:

  • Is the biohazard kit complete and updated?

  • Explain correction to be made:

After Hours

Security system

  • Test your security system and all panic buttons if present, record the date of test and company name.

  • Do all screamers on doors work?

  • Are all security motion sensors/door alarms operational?

  • Explain correction to be made:

  • Are there any current issues with your security system that require bypassing?

  • Explain correction to be made:

  • Does this location have 24-hour access?

  • Is there contact information posted for members in case of emergency?

  • Explain correction to be made:

  • Are all panic necklace alarms operational?

  • Explain correction to be made:

  • Do all mag locks/doors unlock and lock as required?

  • Explain correction to be made:

  • Is all signage up to date and relevant in 24-hour access?

  • Explain correction to be made:

Camera Systems

  • Are all cameras recording?

  • Explain correction to be made:

  • Does the camera system have the ability to save videos?

  • Explain correction to be made:

  • Are all cameras working properly?

  • Explain correction to be made:

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.