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
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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:
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