Free Nursing Home Safety Checklist Form Template

Nursing Home Safety Checklist Form

Please provide all the necessary information below to customize this form.

Facility Name

    Date of Inspection

      Inspector Name

        Location

          General Safety and Environment

          Lighting

            • Adequate lighting in all common areas and resident rooms

            • Emergency lighting operational

            Flooring and Walkways

              • Floors are clean, dry, and free of obstructions

              • Handrails and guardrails are secure and in good condition

              Fire Safety

                • Fire extinguishers are accessible, properly labeled, and inspected

                • Smoke detectors and alarms are functioning

                • Emergency exit routes are clearly marked and unobstructed

                Security Measures

                  • Doors and windows lock properly

                  • Entry points have restricted access

                  Health & Sanitation

                  Cleanliness

                    • Common areas are sanitized regularly

                    • Restrooms are clean and stocked with supplies

                    Waste Disposal

                      • Medical and general waste bins are clearly labeled and regularly emptied

                      • Hazardous waste is handled and stored per regulatory guidelines

                      Emergency Preparedness

                      Evacuation Plans

                        • Evacuation routes and procedures are posted and updated

                        • Staff is trained in emergency response

                        First Aid

                        • First aid kits are stocked and accessible in each unit

                        • Staff is trained in basic first aid and CPR

                        Inspector Manager

                        Date: Date:

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