Information
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Hospital, Floor & Unit Inspected:
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Personnel information (Nurse Manager, email, Person interviewed, Date):
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The Supervisor/Manager is responsible for correcting all conditions that have a "NO" answer in the Unit section. For any Procedural Changes within your environment (improper storage, staff knowledge, etc.) - CORRECT the situation AND CONDUCT the applicable staff training to prevent a reoccurrence of the hazard noted.
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Conducted by: Barbara Back Occupational Safety Compliance Officer Office: 804-827-0345 Cell: 804-400-4979
Unit issues
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1) Are space heaters the approved type (oil-filled or ceramic), and in appropriate areas (not in patient treatment or sleep areas)?
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2) Is all cooking equipment the proper type and in designated cooking areas? (No toasters, toaster ovens, electric grills, etc.)
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3) Are wet floors clearly marked with signage, to reduce slipping hazards?
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4) Is the area free of door chocks?
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5) Is the area free of electrical hazards (no damaged cords, extension cords or daisy-chaining surge protectors, etc.)?
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6) Are corridors and passageways free of obstructions? *Note: Code & Isolations Carts are allowed
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7) Are all stairwells clean, free of storage and obstructions?
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8) Are fire doors, fire extinguishers, gas cut-off valves and other emergency equipment unobstructed?
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9) Are all materials stored a minimum of 18 inches from sprinklers heads?
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10) Are Emergency Telephone Number stickers on telephones? (New stickers with *500)
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11) Are the medications properly secured?
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12) Are trash rooms properly secured?
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13) Was the area free from evidence of smoking?
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14) Are storage & equipment rooms free of clutter and unsafe conditions?
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15) Are areas used by patients safe, clean and comfortable?
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16) Is the environment appropriate to the care, treatment, and services provided, and in relation to the age and needs of the patients?
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17) Are all hazardous areas properly identified with signage?
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18) Are all commercial exhaust hoods inspected?
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19) Are chemicals properly stored, labeled, and separated from patient contact/other clean items?
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20) Are chemical spill kits available?
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21) Does staff know how to access the SDS (Safety Data Sheet) for chemicals?
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22) Is Chemical Inventory list updated annually and accessible to employees?'
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23) Are all records maintained for weekly testing of eyewash units?
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24) Are the number of compressed gas cylinders within maximum limits?
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25) Are all compressed gas cylinders properly secured and segregated? (Green rack FULL, Red rack Used/Empty)
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26) Was the "Unit/Department Specific Emergency Preparedness Plan" complete, posted, and updated annually?
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27) Does staff know location and proper use of fire extinguishers?
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28) Does staff know location and proper use of medical gas shut-off valves?
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29) Did the employees observed have RACER & Identification cards? (New RACER cards with*500)
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30) Does staff know how to report a lost Identification Card?
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31) Does the staff know how to access the Safety Manual, Safety & Security Management Plan, and the Emergency Operations Plan?
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32) Does staff know how to report an unsafe condition?
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33) Does staff know how to report safety and security incidents involving patients, visitors or staff?
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34) Does staff know how handle/report medical equipment malfunctions and/or incidents, including when someone is injured by the equipment?
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35) Are medical inspection tags current?
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36) Does staff know the roles & responsibilities of their specific unit/department during a disaster or emergency exercise?
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37) Does staff know of the emergency preparedness exercises that the facility has participated in within the past 12 months?
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38) Have all concerns been identified?
The following issues will be sent to Plant Ops to be addressed.
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39) Were hazards properly safeguarded for any renovations or construction projects underway?
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40) If YES - were documents (construction & hot-works permits, barrier checklist, etc.) posted?
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41) Are ceiling tiles clean and intact?
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42) Are Exit and stairwell doors properly identified and illuminated?
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43) Do fire doors open, close and latch properly?
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44) Are sprinkler heads free from damage, corrosion, foreign materials and paint?
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45) Are all electrical panels free of open gaps and improperly connected breakers in panels?
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46) Are all panels in public areas properly secured?
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47) Are all mechanical/electrical areas free of combustible storage/debris that increase potential for fire or prevent clear access to equipment & controls?
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48) Are electrical outlets and junction boxes undamaged, and have covers?
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49) Have all concerns been identified?
