Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Life safety

  • Do smoke/fire doors close and latch properly?

  • Fire doors designated with BMP labels?

  • Unobstructed closure of smoke/fire doors?

  • Unobstructed access to fire extinguishers?

  • Monthly fire extinguisher checks noted?

  • Unobstructed view of fire alarm pull station?

  • Stairwells clear of storage and properly lit?

  • 18" clearance in sprinkled areas?

  • 24" clearance in non-sprinkled areas?

  • Unobstructed path of egress?

  • Exit lights lit?

  • Fire diamond posted?

  • Audio visual page charts up-to-date?


  • Alarm system checked?

Infection control

  • Absence of Shipping containers?

  • Linen/linen cart properly covered?

  • Clean medical equipment bagged and tagged?

  • Sharps containers filled appropriately?

  • Waterless hand sanitizers dated?

  • No items found stored on floor?

  • Staff food and drink not observed in undesignated areas?

  • Virex bottles in designated areas only? (2-nursery. 1- blood bank. 1-sleep lab)


  • No Handwritten signs found?

  • Signage issues not observed?

Misc. issues

  • Ceiling tiles in good condition?

  • Walls in good condition and free of holes?

  • Floor surfaces clean and free of cracks?

  • Slip, trip, or fall hazards not found?

  • Unauthorized items under sink?

  • Appropriate positive/negative air pressures? (Clean-positive soiled-negative)


  • Oxygen stored correctly?

Equipment safety

  • Absence of Extension cords?

  • Electrical checks on small appliances?

  • Locked electrical panels?

  • Access to electrical panels not blocked?

Food/nutrition areas

  • Open food containers dated properly?


  • Bathrooms clean

  • Horizontal areas free of dust?

  • Cleanliness issues not found?

Clinical safety

  • Medication storage areas locked?

  • No outdated supplies found?

  • Food or drink not found in un-designated areas?

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.