Hospital Safety Compliance Audit Form

Hospital Safety Compliance Audit Form
Please complete this form to assess and document compliance with hospital safety standards.
Auditor Full Name
First NameLast Name
Auditor Email Address
example@example.com
Auditor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Audit
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hospital/Facility Name
Hospital Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code

Safety Compliance Checklist

Rows	Compliant	Non-Compliant	Not Applicable
Fire safety equipment accessible and operational
Emergency exits clearly marked and unobstructed
Staff trained in emergency procedures
Infection control protocols followed
Electrical equipment inspected and maintained
Hazardous materials stored safely
Patient areas clean and free of obstructions
Proper waste disposal procedures in place

Are all fire extinguishers inspected and up to date?
Are infection control supplies (PPE, sanitizers) available in all required areas?
Are emergency evacuation plans clearly displayed?
Observations and Notes
Recommendations for Improvement
Auditor Signature
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