Nurse Call System Audit Form
Use this form to document a nurse call system audit, record system performance, note issues, and capture follow-up actions.
Audit Details
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility / Unit Name
*
Room / Area Audited
*
Auditor Name or Role
*
System Evaluation
System type/version or manufacturer/model
Overall system status
*
Operational
Partially Operational
Out of Service
Needs Repair
Key functionality checks
*
Rows
Pass
Needs Attention
Not Tested
Call light response
1
2
3
Staff alerting
4
5
6
Bed/call button operation
7
8
9
Corridor indicator operation
10
11
12
Findings and Follow-Up
Issues Observed
*
Severity of Issues
*
None
Minor
Moderate
Critical
Follow-Up / Reinspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Audit
Should be Empty: