Title Page
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Conducted on
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Prepared by
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Location
HGH ACT
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EVS cleaning solution on approved list. Near eyewash station is required?
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Are oxygen tanks secured?
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Are oxygen tanks stored in correct full/empty designated location?
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Are negative and positive pressure rooms correct?
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Are ceiling tiles clean and intact?
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Are eyewash stations unobstructed? Able to use hands-free?
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Are electrical panels & pull stations are unobstructed?
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Are paths of egress unobstructed?
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Are patient care areas clean, free of debris?
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Are patient care equipment free of tape residue?
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Are PM's current?
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Are supplies current? (Not outdated?
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Are crash cart logs current and complete? (Issues are addressed?)
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Are crash cart components clean and ready for use?
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Are IV medications are discarded correctly?
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Do IV bags have revised expiration dates written on bag?
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Are defibrillator pads in packaging and ready for patient use? (i.e. they're secure in packaging)
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No other areas of non-compliance.
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Staff Interviewed:
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Honorable Mentions