Title Page

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Reception Area

Environment - Reception Area

  • Are all surfaces smooth impervious (for easy cleaning) and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Are ward or clinic televisions / display screens visibly clean?

  • Are computer systems visibly clean?

  • Are all telephones visibly clean?

  • Are free standing / desk fans visibly clean?

  • Are air vents visibly clean?

Patient Waiting Area

Environment - Patient Waiting Area

  • Are all surfaces smooth impervious (for easy cleaning) and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Are ward or clinic televisions / display screens visibly clean?

  • Are free standing / desk fans visibly clean?

  • Are air vents visibly clean?

Storeroom

Environment - Storeroom

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Are all items of equipment or supplies stored off the floor?

  • Is the environment tidy and uncluttered?

  • Are items stored appropriately?

Surgery / Clinic / Examination Room

Environment - Surgery / Clinic / Examination Room

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Is furniture made of impermeable and washable materials?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Are all surfaces smooth, impervious ( for easy cleaning ) and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Is there a dedicated hand wash basin?

  • Is the hand wash basin plug free?

  • Is the hand wash basin overflow free?

  • Is the waste offset so the water does not flow directly into it?

  • Are elbow / sensor taps available?

  • If no elbow or sensor taps, are staff aware of how to turn off the taps with a paper towel?

  • Are mixer taps or the thermostatically controlled water available?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins free from extraneous items?

  • Is the soap dispensed from a single use cartridge?

  • Is the liquid soap dispenser wall mounted?

  • Is the soap dispenser visibly clean?

  • Are paper towels available from an enclosed dispenser?

  • Is the paper towel dispenser visibly clean?

  • Is there a promotional hand hygiene poster displayed?

  • Is there a hands-free domestic waste bin available for the disposal of paper towels?

  • Is the foot pedal of the domestic waste bin in good working order?

  • Is the domestic waste bin visibly clean, including lid and pedal?

  • Is the domestic waste bin in good condition?

  • Are alcohol based hand rub bottles available at the point of care?

  • Are alcohol based hand rub dispensers visibly clean?

  • Are bed and trolley bases, including cot sides, visibly clean and free from dust?

  • Is there evidence of an audit programme to check the condition of bed mattresses, couch mattresses and covers?

  • Is the examination couch cover impervious and washable?

  • Are covers to mattresses / examination couches / tilt tables in a good state of repair?

  • Do pillows have an impervious cover or are laundered on patient discharge?

  • Are pillows visibly clean and in a good state of repair?

  • Are all curtains visibly clean and on a cleaning / replacement schedule?

  • Are computer systems visibly clean?

  • Are all telephones visibly clean?

  • Are free standing / desk fans visibly clean?

Back Corridor Clinic / Examination Room

Environment - Back Corridor

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Is furniture made of impermeable and washable materials?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Are all surfaces smooth, impervious and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Is there a designated hand wash basin?

  • Is the hand wash basin plug free?

  • Is the hand wash basin overflow free?

  • Is the waste offset so the water does not flow directly into it?

  • Are elbow / sensor taps available?

  • If no elbow or sensor taps, are staff aware of how to turn off the taps with paper towel?

  • Are mixer taps or the thermostatically controlled water available?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins free from extraneous items?

  • Is the soap dispensed from a single use cartridge?

  • Is the liquid soap dispenser wall mounted?

  • Is the soap dispenser visibly clean?

  • Are paper towels available from an enclosed dispenser?

  • Is the paper towel dispenser visibly clean?

  • Is there a promotional hand hygiene poster displayed?

  • Is there a hands-free domestic waste bin available for the disposal of paper towels?

  • Is the foot pedal of the domestic waste bin in good working order?

  • Is the domestic waste bin visibly clean, including lid and pedal?

  • Is the domestic waste bin in good condition?

  • Are alcohol based hand run bottles available at the point of care?

  • Are alcohol based hand rub dispensers visibly clean?

  • Are bed and trolley bases, including cot sides, visibly clean and free from dust?

  • Is there evidence of an audit programme to check the condition of the mattresses, couch mattresses and covers?

  • Is the examination couch cover impervious and washable?

  • Are covers to mattresses / examination couches / tilt tables in a good state of repair?

  • Do pillows have an impervious cover or are laundered on patient discharge?

  • Are pillows visibly clean and in a good state of repair?

  • Are all curtains visibly clean and on a cleaning / replacement schedule?

  • Are computer systems visibly clean?

  • Are all telephones visibly clean?

  • Are free standing / desk fans visibly clean?

Disabled Toilets

Environment - Disabled Toilets

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Are all surfaces smooth, impervious and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Is there a designated hand wash basin?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins fee from extraneous items?

  • Is the soap dispensed from a single use cartridge?

  • Is the liquid soap dispenser wall mounted?

  • Is the soap dispenser visibly clean?

  • Are paper towels available from an enclosed dispenser?

  • Is the paper towel dispenser visibly clean?

  • Is there a hands-free clinical waste bin available for the disposal of paper towels?

  • Is the foot pedal of the clinical waste bin in good working order?

  • Is the clinical waste bin visibly clean, including lid and pedal?

  • Is the domestic waste bin in good condition?

  • Are toilets visibly clean?

  • Are the toilets in a good state of repair?

  • Are toilets fe from inappropriate items?

  • Are raised toilet seats visibly clean and stored off the floor?

Toilets

Environment - Toilets

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Are all surfaces smooth, impervious and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Is there a designated hand wash basin?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins free from extraneous items?

  • Is the soap dispensed from a single use cartridge?

  • Is the liquid soap dispenser wall mounted?

  • Is the soap dispenser visibly clean?

  • Are paper towels available from an enclosed dispenser?

  • Is the paper towel dispenser visibly clean?

  • Is there a hands-free clinical waste available for the disposal of paper towels?

  • Is the foot pedal of the clinical waste bin in good working order?

  • Is the clinical waste bin visibly clean, including lid and pedal?

  • Is the domestic waste bin in a good condition?

  • Are toilets visibly clean?

  • Are the toilets in a good state of repair?

  • Are toilets free from inappropriate items?

  • Are raised toilet seats visibly clean and stored off the floor?

Clean Utility

Environment - Clean Utility

  • Is the environment visibly clean?

  • Is the environment free from visible damage?

  • Is furniture made of impermeable and washable materials?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Are all surfaces smooth, impervious and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Is there a designated hand wash basin?

  • Is the hand wash basin compliant?

  • Are elbow / sensor taps available?

  • If no elbow or sensor taps, are staff aware of how to turn off the taps with a paper towel?

  • Are mixer taps or thermostatically controlled water available?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins free from extraneous items?

  • Is the liquid soap dispenser wall mounted?

  • Is the soap dispenser visibly clean?

  • Are paper towels available from an enclosed dispenser?

  • Is the paper towel dispenser visibly clean?

  • Is there a promotional hand hygiene poster displayed?

  • Is there a hands-free domestic waste bin available for the disposal of paper towels?

  • Is the foot pedal of the domestic waste bin in good working order, clean and in good condition?

  • Is there a designated work surface / trolley for clinical procedures? i. e. dressings

  • Are dressing trolleys / trays structurally sound and in a good state of repair / clean?

Dirty Utility

Environment - Dirty Utility

  • Is the environment visibly clean?

  • Is the environment free from and visible damage?

  • Is furniture made of impermeable and washable materials?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Are all work surfaces smooth, impervious, with coved edges to facilitate easy cleaning?

  • Are all work surfaces visibly clean?

  • Is the dirty utility room free from clutter and inappropriate items?

  • Is there a designated hand wash basin?

  • Are mixer taps or thermostatically controlled water available?

  • Is the hand wash basin accessible?

  • Is the hand wash basin in a good state of repair?

  • Is the hand wash basin visibly clean?

  • Are hand wash basins free from extraneous items?

  • Are paper towels available from an enclosed dispenser?

  • Is there a promotional hand hygiene poster displayed?

  • Is there a hands-free domestic waste bin available for the disposal of paper towels?

  • Is the foot pedal of the domestic waste bin in good working order?

  • Is the domestic waste bin visibly clean, including lid and pedal?

  • Is the domestic waste bin in good condition?

  • Is there a dedicated deep sink for washing used equipment?

  • Is there a disposal unit available for the disposal of body fluids?

  • Are cleaning / disinfectant products available for decontamination of equipment and the environment?

  • Can staff describe which products should be used for routine cleaning and the correct dilution?

  • Are spillage kits or alternatives available for use on body fluid spillages?

  • Are staff aware of the procedures to be used when removing body fluid spillages?

  • Is personal protective equipment available?

  • Is the macerator or bedpan washer visibly clean?

  • Is the macerator or bedpan washer in good working order?

  • Are bed pans and urinals stored correctly to minimise contamination?

  • Are commodes in a good state of repair?

  • Are commodes visibly clean and ready for use, with up-to-date cleaning record?

  • Is there a system in place to check commodes are clean and ready for use?

  • Are wash bowls disposable or named single patient use?

  • Is the room free from communal items?

  • Are reusable catheter stands of an easily cleanable design?

  • Are catheter stands visibly clean?

  • Are measuring jugs either disposable or processed through a washer disinfector?

  • Is there a hands free waste bin available for the disposal of infectious / healthcare risk waste?

Domestic Cleaning Room / Cupboard

Environment - Domestic Cleaning Room / Cupboard

  • Is there a dedicated room for storage of cleaning equipment?

  • Is the environment visibly clean?

  • Is the environment free from any visible damage?

  • Are all furnishings and fittings visibly clean?

  • Are all furnishings and fittings in a good state of repair?

  • Are all surfaces smooth, impervious and with coved edges?

  • Is the flooring in a good state of repair?

  • Floors including edges and corners are free from dust and grit?

  • Equipment used by the domestic staff is clean, well maintained and stored in a locked area?

  • Machines used for floor cleaning are clean and dry?

  • No inappropriate materials or equipment are stored in the domestic rooms?

  • Products used for cleaning and disinfection comply with policy and are used at the correct dilution?

  • Diluted products are discarded after 24 hours?

  • Personal protective clothing is available and appropriately used?

  • Information on the colour coding system in use is available in the domestics room?

  • Hand hygiene facilities are available for domestic use?

Water Coolers / Water Dispensers

Environment - Water Coolers / Water Dispensers

  • Are water coolers / ice machines on a portable supply e.g. mains or treated water supply?

  • Is the water cooler / ice making machine cleaned at least once a week according to the manufacturers instructions?

  • Is the water cooler / ice machine on a planned maintenance programme?

  • If used for consumption, does the ice making machine dispense ice from a nozzle directly into a receptacle on demand?

Linen Management

Environment - Linen Management

  • Is there a designated clean storage area fro clean linen?

  • Is the environment visibly clean?

  • Is the flooring in a good state of repair?

  • Is all linen stored off the floor?

  • Is the area / room used to store clean linen free from inappropriate items?

  • Is used linen placed directly into appropriate colour coded bags / containers at the point of use?

  • Are water-soluble bags used for soiled and / or infected linen?

  • Are used linen bags / containers less than 2/3rds full?

  • Are rigid linen skips visibly clean?

  • Is used linen stored in a designated area until collections e.g. sluice rooms, dirty utility room?

Ward / Department Kitchen

Environment - Ward / Department Kitchen

  • The floor is free from dust, grit, litter, marks, water or other liquids?

  • Inaccessible areas ( edges, corners and around furniture ) are free from dust, grit, lint and spots?

  • There are no inappropriate items or equipment in the kitchen?

  • There is no evidence of infestation or animals in the kitchen?

  • Fly screens are in place where required?

  • There is a policy regarding patient and visitor access to the kitchen?

  • Cleaning materials used in the kitchen are identifiable ( e.g. colour coded ) and are stored separately to other ward cleaning equipment and away from food?

  • Hand wash sink, liquid soap and disposable paper towels are available?

  • Hands are decontaminated and a clean plastic apron is worn to serve patients meals and drinks?

  • Fixtures and fittings are in a good state of repair?

  • Fixtures, surfaces and appliances are free of grease, dirt, dust, deposits, marks, stains and cobwebs?

  • Shelves, cupboards and drawers are clean inside and out, free from damage, dust, litter or stains and in a good state of repair?

  • Kitchen trolleys are clean and in a good state of repair?

  • Refrigerators / freezers are clean and free of ice build up?

  • There is a thermometer in the fridge and freezer?

  • There is evidence that daily temperatures are recorded and appropriate action is taken if standards are not met ( refrigerators temperature must be less than 8 degrees or as local policy freezer temperature -18 degrees?

  • Patient and staff food in the fridge is labelled with name and date?

  • There are no drugs / blood for transfusion or pathology specimens in the fridge?

  • Microwaves are visibly clean?

  • Where local policy allows a microwave to be used to heat patient food a temperature probe is used to ensure correct temperature has been reached?

  • Toasters are visibly clean?

  • Milk coolers are visibly clean?

  • Bread is stored in a clean bread bin?

  • All food products are within their expiry date?

  • All opened food is covered or stored in containers?

  • Milk is stored under refrigerator conditions?

  • Water coolers and ice machines for patient use are manis supplied?

  • Water coolers are visibly clean and on a pre-planned maintenance programme?

  • Ice machines are visibly clean and on a pre-planned maintenance programme?

  • Scoop used for ice is stored outside the machine in a lidded container?

  • There is a satisfactory system for cleaning crockery and cutlery such as central wash-up or dishwasher, achieving disinfection temperatures evidence by a maintenance programme.

  • Disposable paper roll is available for drying equipment and surfaces?

  • Waste bins are foot operated and in good working order?

  • Waste bins are clean and labelled 'for general waste'?

Management of Equipment

Patient Equipment - Management of Equipment

  • Is all equipment detailed on a cleaning schedule?

  • Are schedules completed, signed and up to date with frequencies and responsibilities identified?

  • Are items sent for service, inspection or repair, appropriately cleaned and / or disinfected, and a label or contamination status attached?

  • Is loaned equipment decontaminated prior to use unless received from an accredited sterile services department / unit?

  • Are sterile products stored above floor level?

  • Are sterile packs sealed and undamaged?

  • Are all sterile packs in date?

  • Can staff describe the symbol used to indicate single use items?

  • Are all re-usable instruments returned to a sterile services provider for decontamination?

  • Are cleaning products available for routine cleaning of equipment?

Mobile Equipment

Patient Equipment - Mobile Equipment

  • Is mobile equipment such as drug trolleys, notes trolleys, mobile x-rays, ultrasound equipment visibly clean?

  • Is there a system to routinely clean mobile equipment and is this monitored?

Monitoring & Pyhsiological Equipment

Patient Equipment - Monitoring and Physiological Equipment

  • Is all equipment in a good state of repair?

  • Is blood pressure monitoring equipment visibly clean?

  • Are all stethoscopes visibly clean?

  • Is blood glucose monitoring equipment visibly clean?

  • Is all reusable equipment routinely cleaned between every patient with general purpose detergent or as per local policy / manufacturers instructions, where this differs?

  • Are IV stands / pumps visibly clean?

  • Are monitoring leads / straps decontaminated between patients?

  • Are tourniquets single use or decontaminated between patients?

Resuscitation Equipment

Patient Equipment - Resuscitation Equipment

  • Are items on the resuscitation trolley visibly clean?

  • Is resuscitation equipment either single use or reprocessed through a sterile services provider?

  • Is the suction machine visibly clean and dry?

  • Are nebulisers stored clean and dry between uses?

  • Are disposable suction liners used and changed between patients?

Manual Handling Equipment

Patient Equipment - Manual Handling Equipment

  • Is manual handling equipment stored appropriately?

  • Are manual handling slings / sheets single use or laundered after use?

  • Are hoists visibly clean and in a good state of repair?

  • Are PAT (Patient Assisted Transfer) slides stored off the floor?

Miscallaneous Equipment

Patient Equipment - Miscellaneous Equipment

  • Are aids such as walking sticks, Zimmer frames, helping hands visibly clean and stored in a suitable area?

  • Are wheelchairs visibly clean and n a good state of repair?

  • In paediatric areas toys are visibly clean?

  • Are toys made of cleanable materials?

  • Is stored patient equipment e.g. IV stands, pumps, mattresses, bariatric equipment visibly clean and ready for use, and identified as such?

Personal Protective Equipment

Personal Protective Equipment - Personal Protective Equipment

  • Are single use plastic aprons available?

  • Are single use plastic aprons stored appropriately away from risk of contamination?

  • Are single use apron sworn as single use items and changed between every patient?

  • Is there a range of sizes of sterile and non-sterile powder free gloves available?

  • Are gloves stored appropriately?

  • Are gloves worn when in contact or anticipated contact with bodily fluids or in potential contact with contaminated items?

  • Are gloves removed after care activity and hand hygiene performed?

  • Is eye and face protection worn by staff when anticipating contact with blood and bodily fluids with a high risk of splashing in the face and eyes?

RGDU / TAIRU

Patient Waiting Area - RGDU / TAIRU

  • Are all surfaces smooth impervious and with coved edges?

  • Is the floor visibly clean?

  • Is the floor covering washable and impervious to moisture?

  • Is the flooring in a good state of repair?

  • Are ward or clinic televisions / display screens visibly clean?

  • Are free standing / desk fans visibly clean?

  • Are air vents visibly clean?

  • Are hand hygiene facilities available?

  • Are equipment cleaning wipes available?

  • Are the air conditioning unites clean and free from dust?

  • Is there a planned programme of maintenance of the air conditioning units?

  • Are patient dressing trolleys available and free from dust / debris?

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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.