Healthcare Internal Audit Checklist Form
Use this Healthcare Internal Audit Checklist Form to document audit details, checklist items, and findings for internal healthcare process reviews.
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Name
*
First Name
Last Name
Department or Process Audited
*
Checklist: Select all items reviewed and compliant
*
Policies and procedures are up to date
Staff training records are complete
Patient documentation standards met
Equipment maintenance logs available
Infection control protocols followed
Other (specify in findings)
Overall Compliance Rating
*
1
2
3
4
5
Summary of Findings
*
Recommended Follow-up Actions
Next Audit Due Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Audit
Should be Empty: