Title Page
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Audit Title
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Conducted on
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Inspected By
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Location
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Entrance to Area/Division Clean and Presentable? (Overall First Impression of area/unit)?<br>
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Disinfection wipe container lids closed and labeled correctly? Chemical Dispensing unit in working condition?
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Eye Wash sheets properly dated? (Unblocked)
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Hopper rooms clean and in order? (No unnecessary items)
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Hopper Room locked when not in use?
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Housekeeping carts clean and free of unnecessary item?
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Cart Locked and put away when not in use?
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Equipment clean? (Vacuums, buffers & carts)
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Staff have knowledge of R.A.C.E. (Rescue Alarm Contain Extinguish) and P.A.S.S. (Pull Aim Squeeze Sweep.)?
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Staff have knowledge of Dwell time for Disinfectant? (Name of Disinfectant)
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Performex?
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Clorox Hydrogen Peroxide?
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Does staff have knowledge of SDS? What is SDS? (Safety Data Sheets) Where is the SDS information located?
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P.P.E. Available? (Gloves, Goggles is there evidence of use?)
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Staff have knowledge of location of Fire Pull Stations?
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Soiled Utility rooms cleaned & organized?
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Green Trash & Red Bio Hazard carts cleaned & lined? (McClure Carts)
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Hand Hygiene Being Performed? (Observation of Evidence)
