Staff & Staff Knowledge

All staff must wear names badges at chest level with photo ID visible
Staff can identify nearest fire alarm pull station.
Staff know the location of the nearest fire extinguisher.
Staff can verbalize how to use a fire extinguisher (P.A.S.S.)
Staff can describe what to do in case of fire (R.A.C.E.).
Staff know the process for notifying primary care physicians and/or family of their hospitalization if asked by the patient.
Pt information (White board, WOWs & Chart) secured to ensure privacy
Check for expired meds or supplies throughout the unit
Staff are using 2 patient identifiers in compliance with hospital policy (patient identification, specimen labeling, etc.)
No other non-compliant findings.

EOC Exits & Egress

Egress is clear. Exit doors are not blocked and clear of clutter
Fire rated doors must latch & close properly
No flammable items on fire rated doors
Hallways clear with all equipment parked on one side or in alcoves
Nothing in front of medical gas valves, fire extinguishers or pull stations
No doorstops used or doors propped open
No food or beverages in patient care areas or nurse’s stations
No supplies stored within 18 inches from bottom of sprinkler head
No unattended meds on Pyxis, WOWs, or throughout the unit
All Pt. equipment labeled with clinical engineering sticker & current PMs
O2 tanks upright in holder, full and empty tanks separated with signage
No other non-compliant findings.

Med Room

Med Prep areas are clean, uncluttered and separated from other areas
Med rooms locked with access for authorized personnel only
All insulin or multi-use vials are dated w/discard date in 28 days
Pill cutters are individual use only. Must be labeled with patient name
Med refrigerator and freezer temp logs documented daily
Out of range temperatures are addressed.
Med room checked for expired meds & supplies
No other non-compliant findings.

Crash Cart

Defibrillator is plugged in.
Crash Cart tidy and clean. No dust or excessive supplies on crash carts
Crash cart logs and Defibrillator check documented daily. Lock is intact and matches log documentation.
Patches for leads are closed and sealed in their original packages.
No other non-compliant findings.

Waived Tests

Glucometers cleaned, Controls and Strips dated w/date opened/expiration date; toss after 90 days
No expired supplies.
No other non-compliant findings.

Infection Control

Staff can verbalize or demonstrate proper donning and doffing of PPE.
Contact Precaution sign posted and isolation cart placed outside of room
Overall cleanliness of unit (floors, walls, clutter, dust)
Nothing stored under sinks throughout unit
Hand hygiene performed when staff entering & exiting patient rooms
Hand gel stocked in all dispensers
No open Sani-Cloth containers
No gloves, booties, hanging face masks while in hallway or public areas
No other non-compliant findings.

Patient Pantry/Kitchen

Patient food must be labeled with Pt. name and date
No staff food to be stored in patient refrigerator
Refrigerator temp checked daily & documented daily by dietary services
No other non-compliant findings.

Clean Utility Room

Linen carts must be covered and have solid bottoms
All linen and supply carts must have solid bottom on lower shelf
No supplies stored on the floor. Must be on pallets or wire shelving
No corrugated shipping boxes. Remove immediately
No other non-compliant findings.

Soiled Utility Room

Equipment requiring cleaning or service must be clearly marked
Used instruments for reprocessing are stored in a biohazardous-labeled rigid container and wet with enzymatic detergent.
Enzymatic detergent, rigid biohazardous-labeled bin and PPE are available for contaminated instrument storage until delivered to SPD.
No clean supplies or items to be stored in soiled utility rooms
All biohazard containers must be clearly labeled and covered with a lid
No other non-compliant findings.


Was any Service Recovery required? If yes, please explain:

Please share any Staff Recognition:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.