AMR Safety Inspections - Rev January 2014

• Conducted on

  Date

• Prepared by

Garage / Fleet Safety Checklist

• Address / Location
  Address

• Are all permits and records up-to-date?

  Yes

  No

• Is there a first aid kit stocked and accessible?

  Yes

  No

• Is an eye wash station mounted and accessible?

  Yes

  No

• Are fire extinguishers properly charged and mounted in an accessible location?

  Yes

  No

• Fire extinguisher expiration date

  Date

• Are safeguards (exit / emergency light, sprinklers, fire doors, alarm systems, etc.) properly marked and in good working order?

  Yes

  No

  Not Applicable

• Are protective goggles or face shields provided and worn?

  Yes

  No

  Not Applicable

• Is protective equipment in sanitary condition?

  Yes

  No

  Not Applicable

• Is rest/eating area free of toxic material?

  Yes

  No

  Not Applicable

• Are spills cleaned up immediately?

  Yes

  No

  Not Applicable

• Are oily rags in covered cans?

  Yes

  No

  Not Applicable

• Are work areas adequately illuminated?

  Yes

  No

  Not Applicable

• Are all exits kept free of obstructions?

  Yes

  No

  Not Applicable

• Are all floor openings covered or guarded?

  Yes

  No

  Not Applicable

• Are all tools / equipment in good working condition?

  Yes

  No

  N/A

• Are all tools / equipment free from damage (broken handles, etc.)

  Yes

  No

  Not Applicable

• Are all moving parts on equipment guarded? (lock out / tag out)

  Yes

  No

  Not Applicable

• Are compressors drained of water build up twice a week?

  Yes

  No

  Not Applicable

• Are appropriate hazard signs posted?

  Yes

  No

  Not Applicable

• Are all containers labeled as to their contents?

  Yes

  No

  Not Applicable

• Are flammable liquids stored properly?

  Yes

  No

  Not Applicable

• Are MSDS current?

  Yes

  No

  Not Applicable

• Is the area around electrical boxes kept clear?

  Yes

  No

  Not Applicable

• Are all openings provided with covers?

  Yes

  No

  Not Applicable

• Are ladders in good working order?

  Yes

  No

  Not Applicable

• Is equipment to control spills accessible?

  Yes

  No

  N/A

• Are toilets and washing facilities clean and sanitary?

  Yes

  No

  Not Applicable

• Are all items at least 24" from ceiling?

  Yes

  No

  Not Applicable

• Photos

  Media

• Comments and Notations of Deficiencies

Office Safety Checklist

• Location
  Address

• Are filing cabinets anchored and materials stored to prevent tipping?

  Yes

  No

  Not Applicable

• Are furniture / fixtures free of all sharp edges?

  Yes

  No

  Not Applicable

• Is there adequate illumination in all areas?

  Yes

  No

  Not Applicable

• Are aisles and passageways clear to provide unobstructed movement?

  Yes

  No

  Not Applicable

• Are all exits properly lighted / marked?

  Yes

  No

  Not Applicable

• Are stairway doors and exit(s) kept closed?

  Yes

  No

  Not Applicable

• Are standard handrails used on all stairways over four (4) steps?

  Yes

  No

  Not Applicable

• Are floors free from spills / hazards?

  Yes

  No

  Not Applicable

• Are fire extinguishers mounted in accessible locations?

  Yes

  No

• Spot check extinguisher location (room / office / location)

• Expiration Date

  Date

• Is there a first aid kit accessible?

  Yes

  No

• Are safeguards (exit/emergency light, sprinklers, fire doors, alarm systems, etc.) properly marked and in good working order?

  Yes

  No

• Are cords / cables secured to prevent hazards?

  Yes

  No

• Are all items greater than 24" from the ceiling?

  Yes

  No

• Comments

• Photos

  Media

Ambulance Safety Checklist

• Add location
  Address

• Select date

  Date

• Vehicle Fender Number Inspected

• Are all permits / licenses current?

  Yes

  No

• Are all fire extinguishers recharged and accessible?

  Yes

  No

• Are gloves worn on all patient contacts?

  Yes

  No

  Not Applicable

• Are safety glasses readily accessible and used?

  Yes

  No

  Not Applicable

• Is the ambulance clean and orderly?

  Yes

  No

• Is soiled linen stored away to prevent contamination of the unit?

  Yes

  No

  Not Applicable

• Is all equipment stored in such a way to prevent it from moving?

  Yes

  No

  Not Applicable

• Are all used sharps disposed of in a sharps container?

  Yes

  No

  Not Applicable

• Is all contaminated waste red-bagged and labeled?

  Yes

  No

  Not Applicable

• Does the crew use their seat belts?

  Yes

  No

  Not Applicable

• Is the waste disposal adequate?

  Yes

  No

  Not Applicable

• Pre Trip Inspection checklist completed?

  Yes

  No

  Not Applicable

• Does the crew use proper clean-up techniques after each call?

  Yes

  No

  Not Applicable

• Is temporary hand washing station available (ETOH Solution)

  Yes

  No

• Photos

  Media

• Comments and Notations of Deficiencies

Supply Safety Checklist

• Add location
  Address

• Are file cabinets anchored and materials stored to prevent tipping?

  Yes

  No

  Not Applicable

• Are furniture / fixtures free of sharp edges?

  Yes

  No

  Not Applicable

• Is there adequate illumination in all areas?

  Yes

  No

• Aisles and passageways clear to provide unobstructed movement?

  Yes

  No

• Are all exits kept free of obstructions?

  Yes

  No

• Are floors provided with non-slip surface?

  Yes

  No

• Are exits properly lighted / marked?

  Yes

  No

• Are materials stored in a manner to prevent falling?

  Yes

  No

• Are floors free from spills / hazards?

  Yes

  No

• Are fire extinguishers properly charged and mounted in an accessible location?

  Yes

  No

• (Room, Office, Location)

• Expiration Date

  Date

• Are smoke / carbon monoxide detectors present and working?

  Yes

  No

• Is the sprinkler system free from obstructions?

  Yes

  No

  Not Applicable

• Are cords / cables secured to prevent hazards?

  Yes

  No

• Are storage areas clean and orderly?

  Yes

  No

• Are electrical cords used properly?

  Yes

  No

  Not Applicable

• Is electrical equipment in good condition?

  Yes

  No

  Not Applicable

• Are electrical panels always kept closed?

  Yes

  No

  Not Applicable

• Is waste disposal adequate?

  Yes

  No

  Not Applicable

• Are all items at least 24" from ceiling?

  Yes

  No

• Photos

  Media

• Comments and Notations of Deficiencies

Station Safety Checklist

• Station Name

• Add location
  Address

Housekeeping

• Are stairway doors and exit(s) kept closed?

  Yes

  No

  Not Applicable

• Are floors free of spills / hazards?

  Yes

  No

• Are restrooms / washrooms clean and sanitary?

  Yes

  No

• Are all exits kept free from obstructions?

  Yes

  No

• Are floors provided with non-slip surfaces?

  Yes

  No

• Are storage areas clean and orderly?

  Yes

  No

• Are storage areas clean and orderly?

  Yes

  No

• Is waste disposal adequate?

  Yes

  No

  Not Applicable

• Are kitchen areas clean and sanitary?

  Yes

  No

  Not Applicable

• Overall Exterior Appearance

  Satisfactory

  Needs Attention

  Needs Immediate Attention

• Exterior Comments

• Facility has Hot and Cold water available?

  Yes

  No

• Photos

  Media

• Comments and Deficiency Notations

Fire Prevention

• Are smoke and carbon monoxide detectors present and working?

  Yes

  No

• Are safeguards (exit, emergency light, sprinklers, fire doors, alarm systems, etc.) properly marked and in good working order?

  Yes

  No

• Are cords / cables secured to prevent hazards?

  Yes

  No

• Are electrical panels always kept closed?

  Yes

  No

  Not Applicable

• Are electrical cords used properly?

  Yes

  No

• Is electrical equipment in good condition?

  Yes

  No

• Are fire extinguishers properly charged and mounted in an accessible location?

  Yes

  No

• Location of Extinguisher Inside Facility

• Expiration DateAre aisles and passageways clear to provide unobstructed movement?

  Date

• Are aisles and passageways clear to provide unobstructed movement?

  Yes

  No

• Are egress exits properly indicated with visible signage?

  Yes

  No

• Is normal / emergency routes adequately lit for access / egress?

  Yes

  No

• Photos

  Media

• Comments and Notation of Deficiencies

Safety and Physical Hazards

• Are file cabinets anchored and materials stored to prevent tipping?

  Yes

  No

• Are furniture / fixtures free of sharp objects?

  Yes

  No

• Are safeguards available / marked on equipment as needed?

  Yes

  No

• Are materials kept in a manner to prevent falling?

  Yes

  No

• Are all Oxygen tanks secured and placed in racks?

  Yes

  No

• Are non-slip rugs or mats available for slippery floor surfaces?

  Yes

  No

• Are liquid flammable paints properly stored?

  Yes

  No

  Not Applicable

• Are exits properly lighted / marked?

  Yes

  No

• Are portable space heaters equipped with automatic turn off?

  Yes

  No

  Not Applicable

• Are standard handrails used on all stairway over 4 (four) steps?

  Yes

  No

  Not Applicable

• Is there a first aid kit stocked and accessible?

  Yes

  No

• Are combustible / flammable materials kept away from electrical outlets?

  Yes

  No

  Not Applicable

• Are hazardous materials used and stored properly?

  Yes

  No

  Not Applicable

• Is the facility equipped with employee alarm system in accordance with National AMR Emergency Action Plan?

  Yes

  No

• Photos

  Media

• Comments and Notations of Deficiencies