Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Audit Completed By:

  • Supervisor

  • Assessor

SCORING MATRIX DEFINITIONS - 0 = Not Acceptable / 1 = Poor / 2 = Below Standard / 3 = Meets Specification / 4 = Good / 5 = Excellent

  • 0 = Not Acceptable / 1 = Poor / 2 = Below Standard / 3 = Meets Specification / 4 = Good / 5 = Excellen

Entrance & Foyer

  • External Entry (Litter, Swept, Hosed)

  • Everything meet standrads? Take a picture of it

  • Entrance Glass

  • Everything meet standrads? Take a picture of it

  • Floors

  • Everything meet standrads? Take a picture of it

  • Handrails

  • Everything meet standrads? Take a picture of it

  • Walls

  • Everything meet standrads? Take a picture of it

  • All bins empty?

Office, Reception, Lounge Area And Staff Rooms

  • Floors

  • Everything meet standrads? Take a picture of it

  • Windows

  • Everything meet standrads? Take a picture of it

  • Workspace

  • Everything meet standrads? Take a picture of it

  • Tables

  • Everything meet standrads? Take a picture of it

  • Walls

  • Everything meet standrads? Take a picture of it

  • All bins empty?

Aerobics Room

  • Floors

  • Everything meet standrads? Take a picture of it

  • Windows

  • Everything meet standrads? Take a picture of it

  • Walls

  • Everything meet standrads? Take a picture of it

Creche

  • Floors

  • Everything meet standrads? Take a picture of it

  • Windows

  • Everything meet standrads? Take a picture of it

  • Walls

  • Everything meet standrads? Take a picture of it

  • All bins empty?

Gym And Weights Room

  • Floors (Including Under Treadmills)

  • Everything meet standrads? Take a picture of it

  • Windows

  • Everything meet standrads? Take a picture of it

  • Walls (Including Easements)

  • Everything meet standrads? Take a picture of it

  • Drink Fountains

  • Everything meet standrads? Take a picture of it

  • All bins empty?

Changerooms

  • Floors

  • Everything meet standrads? Take a picture of it

  • Matting

  • Everything meet standrads? Take a picture of it

  • Walls

  • Everything meet standrads? Take a picture of it

  • Tiles

  • Everything meet standrads? Take a picture of it

  • Showers

  • Everything meet standrads? Take a picture of it

  • Basins

  • Everything meet standrads? Take a picture of it

  • Mirrors

  • Everything meet standrads? Take a picture of it

  • Fittings

  • Everything meet standrads? Take a picture of it

  • Urinals

  • Everything meet standrads? Take a picture of it

  • Seating

  • Everything meet standrads? Take a picture of it

  • Drains

  • Everything meet standrads? Take a picture of it

  • All bins empty?

  • Soap replaced?

  • Toilet paper replaced?

ACTION PLAN REQUIREMENT

  • All Previous Action Plan Completed?

  • Action Plan Required For This Audit?

  • Date of Action Plan to be Completed

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.