Baptist Health Environment of Care & Life Safety Rounding Checklist

• Conducted on

  Date

• Prepared by

Department:

Safety Management

• - Compressed gas cylinders properly secured, categorized full vs empty, and do not exceed q’ty limits

  Yes

  No

  N/A

• - Flammable liquids properly stored

  Yes

  No

  N/A

• Flooring/Ceiling Surfaces are intact, undamaged, and free of stains

  Yes

  No

  N/A

• - Chemicals labeled and properly stored

  Yes

  No

  N/A

• - Walking surfaces in good repair

  Yes

  No

  N/A

• - Tripping hazards are not present

  Yes

  No

  N/A

• - Adequate precautions taken during remodeling or construction

  Yes

  No

  N/A

• - Radiation, laser, biological hazards clearly identified

  Yes

  No

  N/A

• Pt care and medication refrigerators are labeled, clean, and logs current

  Yes

  No

  N/A

• Pt foods are dated and within expiration ranges

  Yes

  No

  N/A

• Cabinets under sinks are clean and not used for storage

  Yes

  No

  N/A

• Proper hand hygiene is followed

  Yes

  No

  N/A

Fire Safety Management

• - Fire doors, pull stations, and egress routes are clear

  Yes

  No

  N/A

• Trash/Linen Chutes are secured and properly close & latch

  Yes

  No

  N/A

• - Storage at least 18” below sprinkler heads

  Yes

  No

  N/A

• Stored supplies are elevated off the floor with solid shelving

  Yes

  No

  N/A

• - Fire extinguishers inspected monthly

  Yes

  No

  N/A

• Fire Extinguishers are mounted properly and at within appropriate heights

  Yes

  No

  N/A

• Sprinkler heads are clean and unobstructed

  Yes

  No

  N/A

• Fire doors latch and close properly w/ < 1/8” gap

  Yes

  No

  N/A

• - Patient rooms doors close and latch properly

  Yes

  No

  N/A

• - Satisfactory housekeeping/sanitation

  Yes

  No

  N/A

• - Exhaust ventilation system functioning

  Yes

  No

  N/A

• - Stairway, ramps, handrails in good condition, free of obstacles and storage

  Yes

  No

  N/A

• - No flammable decorations

  Yes

  No

  N/A

• - No doors propped open

  Yes

  No

  N/A

• - Electrical panels are closed, latched, and unobstructed

  Yes

  No

  N/A

• Hand foam canisters are within expiration date

  Yes

  No

  N/A

Security

• - Personal belongings secure

  Yes

  No

  N/A

• - Medication room secure

  Yes

  No

  N/A

• - Co-workers wearing identification badges

  Yes

  No

  N/A

• Staff can explain security process for forensic patients

  Yes

  No

  N/A

• Access control properly functions

  Yes

  No

  N/A

• Staff can explain their role in an infant abduction

  Yes

  No

  N/A

Hazmat & Waste

• Staff can demonstrate SDS

  Yes

  No

  N/A

• Hazardous waste is properly stored

  Yes

  No

  N/A

• Janitors closets are secured

  Yes

  No

  N/A

• Eyewash station is current on logs

  Yes

  No

  N/A

• There is appropriate PPE in area

  Yes

  No

  N/A

Infection Control

• - Soiled linen covered and not overflowing

  Yes

  No

  N/A

• Medical equipment is clean (sticker free) and in good repair

  Yes

  No

  N/A

• - Sharps containers not overfilled

  Yes

  No

  N/A

• Clean utility is segregated from dirty

  Yes

  No

  N/A

• Proper Air pressure is maintained

  Yes

  No

  N/A

Utilities Management

• - Lights in good working order

  Yes

  No

  N/A

• - Extension cords not in use for permanent power

  Yes

  No

  N/A

• - Multistrip outlets are hospital-grade

  Yes

  No

  N/A

• - Air supply and returns clean

  Yes

  No

  N/A

• - Medical gas zone valves in good condition, properly labeled, clean, and unobstructed

  Yes

  No

  N/A

• - Emergency lighting for exit signs operable and arrows pointed correctly

  Yes

  No

  N/A

• - Air pressure relationships are correct (clean rooms are positively pressured, dirty rooms are negative)

  Yes

  No

  N/A

HIPPA Concerns

• - Inappropriate staff discussion of PHI overheard in area

  Yes

  No

  N/A

• - Documents containing PHI concealed from public access and view

  Yes

  No

  N/A

• - Pt info boards include minimum pt information

  Yes

  No

  N/A

Water Management Optional

• Water Sample Location 1

• Temperature

• Water Sample Location 2

• Temperature

• Water Sample Location 3

• Temperature

• Water Sample Location 4

• Temperature

• Water Sample Location 5

• Temperature

Other Deficiencies Noted