Title Page
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Site conducted
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Document No.
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Audit Title
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Conducted on
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Prepared by
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Location
Is this location a staffed club?
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Select YES or NO
Employee Training
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First Aid/AED certified employees available to assist in an emergency?
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Explain correction to be made:
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Is there an updated contact list at the Member Support desk?
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Explain correction to be made:
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Is the MOD schedule posted and accessible by all staff?
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Explain correction to be made:
Ask 2 employees (other than front desk) where AED is located and what it is for.
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Employee #1 name:
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Employee #2 name:
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Were all employees able to locate and describe purpose of AED?
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Explain correction to be made:
SDS - Ask 3 employees from different departments what an SDS is and where the binder is located.
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Employee #1 name:
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Employee #2 name:
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Employee #3 name:
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Were all employees able to describe the purpose and location of the SDS?
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Explain correction to be made:
Incident Reports/Property Loss - Ask 3 employees from different departments the purposes and processes for filing an incident report.
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Employee #1 name:
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Employee #2 name:
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Employee #3 name:
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Were all employees able to describe the different report forms and the processes for submitting them?
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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.
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Employee #1 Name:
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Employee #2 Name:
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Were both employees able to identify the purpose, content and location of the emergency binder?
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Explain correction to be made:
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Are the emergency procedures in a red binder at the member support desk?
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Explain correction to be made:
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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.
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Employee #1 name:
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Employee #2 name:
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Employee #3 name:
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Were all employees able to describe the proper procedures in case of these events?
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Explain correction to be made:
Ask two employees the hazards of two different chemicals.
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Employee #1 name:
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Two chemicals and their hazards:
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Employee #2 name:
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Two chemicals and their hazards:
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Were both employees able to identify the hazards of the chemicals?
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Explain correction to be made:
Biohazard - Ask two employees what the biohazard kit's purpose is and where it is located.
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Employee #1 Name:
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Employee #2 Name:
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Were all employees able to identify the purpose of the biohazard kit and its location?
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Explain correction to be made:
Emergency Procedures
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Are the emergency procedures posted somewhere or in a red binder?
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Explain correction to be made:
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Photo of the red emergency procedures binder or posted info.
Fire
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Emergency exit signs identifiable and readily visible?
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Explain correction to be made:
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Emergency lights working?
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Explain correction to be made:
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Water shut off valves accessible?
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Explain correction to be made:
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Is there an 18" vertical clearance maintained from sprinkler heads?
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Explain correction to be made:
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Fire alarm pull stations and fire extinguishers visible and unobstructed?
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Explain correction to be made:
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Fire extinguishers checked monthly for green & signed off?
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Explain correction to be made:
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Photo of one signed off extinguisher
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Carbon monoxide detectors working?
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Explain correction to be made:
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Flammables stored in flammable lockers?
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Explain correction to be made:
Earthquake
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Bookcases, filing cabinets, shelves, racks, cages, storage cabinets, and similar items over four feet tall secured?
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Explain correction to be made:
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Large and heavy objects stored at waist level?
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Explain correction to be made:
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In case of power loss, are there working flashlights available in every department?
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Explain correction to be made:
Electrical
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Are electrical panels filled with breakers or metal blanks?
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Explain correction to be made:
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Are electrical panels unobstructed and easy to get to?
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Explain correction to be made:
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Photo of an Electrical Panel
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Is there a diagram explaining what all fuses are for?
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Explain correction to be made:
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Do all tools, equipment, vacuums, extension cords, etc. have electrical cords in good condition with no frays, with grounding plug attached?
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Explain correction to be made:
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Do all lights have effective coverings?
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Explain correction to be made:
Hazardous Materials
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Are all secondary containers properly labeled per GHS requirements?
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Explain correction to be made:
SDS
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Is the SDS current and accurate?
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Explain correction to be made:
Choose two different chemicals and confirm they have SDS sheets in the SDS.
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Chemical #1
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Chemical #1 SDS Sheet
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Chemical #2
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Chemical #2 SDS Sheet
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Did both chemicals have an SDS sheet in the SDS binder?
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Explain correction to be made:
Eye Wash Stations
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Do all chemical storage or chemical mixing areas have eye wash stations?
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Explain correction to be made:
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Do your eye wash stations contain saline solutions?
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Are the saline solutions expired?
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Explain correction to be made:
Respirator Staff
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Does your location require a respirator certified employee?
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Do you currently have a respirator certified employee?
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Picture of respirator certification.
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Does your certified employee have all proper equipment onsite?
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Explain correction to be made:
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Explain correction to be made:
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Does this location have a pool or hot tub WITH a pump room that mixes chemicals?
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Is there PPE available in the pump rooms? (Apron, masks, eye protection, gloves, Etc.)
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Explain correction to be made:
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Is there adequate PPE in chemicals mixing/storage areas?
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Explain correction to be made:
General Housekeeping
Are the following areas/items free of hazards, clean and maintained?
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Storage Rooms?
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Explain correction to be made:
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Mechanical/Pump Rooms?
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Explain correction to be made:
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Maintenance Shops?
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Explain correction to be made:
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Building Exterior?
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Explain correction to be made:
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Offices?
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Explain correction to be made:
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Pool decks?
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Explain correction to be made:
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Water heaters/Boilers/Steamers/Etc.
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Explain correction to be made:
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Cardio/weight room floors clear of trip hazards (carpet strands, threshold joiners, Etc)
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Explain correction to be made:
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Outlet covers
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Explain correction to be made:
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HVAC Systems/Active Pure systems
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Explain correction to be made:
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HEPA filters
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Explain correction to be made:
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Guards on tools
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Explain correction to be made:
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Riser rooms
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Explain correction to be made:
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Laundry rooms/lint traps free of excess lint?
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Explain correction to be made:
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Fitness equipment
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Explain correction to be made:
AED
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AED condition:
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Are the shock pads expired?
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Battery condition:
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Emergency/First Aid Kit Updated?
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Is the Emergency Procedure Red Binder Updated?
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Explain correction to be made:
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Is the biohazard kit complete and updated?
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Explain correction to be made:
After Hours
Security system
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Test your security system and all panic buttons if present, record the date of test and company name.
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Do all screamers on doors work?
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Are all security motion sensors/door alarms operational?
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Explain correction to be made:
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Are there any current issues with your security system that require bypassing?
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Explain correction to be made:
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Does this location have 24-hour access?
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Is there contact information posted for members in case of emergency?
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Explain correction to be made:
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Are all panic necklace alarms operational?
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Explain correction to be made:
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Do all mag locks/doors unlock and lock as required?
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Explain correction to be made:
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Is all signage up to date and relevant in 24-hour access?
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Explain correction to be made:
Camera Systems
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Are all cameras recording?
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Explain correction to be made:
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Does the camera system have the ability to save videos?
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Explain correction to be made:
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Are all cameras working properly?
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Explain correction to be made: