72 lines
1.3 KiB
Markdown
72 lines
1.3 KiB
Markdown
|
# Internal Audit Checklist
|
||
|
|
|
||
|
|
| Form ID | FRM-006 | Revision | 1.0 |
|
||
|
|
|---------|---------|----------|-----|
|
||
|
|
|
||
|
|
---
|
||
|
|
|
||
|
|
## Section 1: Audit Information
|
||
|
|
|
||
|
|
| Field | Entry |
|
||
|
|
|-------|-------|
|
||
|
|
| Audit Date | |
|
||
|
|
| Auditor Name | |
|
||
|
|
| Area/Process Audited | |
|
||
|
|
| Audit Type | [ ] Process [ ] Document [ ] Compliance [ ] Mock Survey |
|
||
|
|
|
||
|
|
## Section 2: Audit Scope
|
||
|
|
|
||
|
|
**Standards/Requirements:**
|
||
|
|
|
||
|
|
**Documents Reviewed:**
|
||
|
|
|
||
|
|
**Personnel Interviewed:**
|
||
|
|
|
||
|
|
## Section 3: Audit Checklist
|
||
|
|
|
||
|
|
| Item # | Requirement | Compliant | Finding | Evidence |
|
||
|
|
|--------|-------------|-----------|---------|----------|
|
||
|
|
| 1 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 2 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 3 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 4 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 5 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 6 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 7 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 8 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 9 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
| 10 | | [ ] Y [ ] N [ ] NA | | |
|
||
|
|
|
||
|
|
## Section 4: Findings Summary
|
||
|
|
|
||
|
|
### Critical Findings (Immediate patient safety risk)
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
### Major Findings (Significant non-compliance)
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
### Minor Findings (Documentation or procedural deviation)
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
### Observations (Opportunities for improvement)
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
## Section 5: Positive Observations
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
## Section 6: Signatures
|
||
|
|
|
||
|
|
| Role | Name | Signature | Date |
|
||
|
|
|------|------|-----------|------|
|
||
|
|
| Auditor | | | |
|
||
|
|
| Auditee | | | |
|
||
|
|
|
||
|
|
---
|
||
|
|
|
||
|
|
*Form FRM-006 Rev 1.0*
|