Information

  • Department(s)

  • Conducted on

  • Prepared by

  • Personnel Involved

  • Room is accessible for patients?

  • The call-bell is functional and within reach of the patient?

  • All equipment alarms are turned on?

  • Staff know steps to follow for medical device malfunction?

  • Patient's privacy is respected (i.e., curtain pulled during care, staff knock before entering)?

  • Nurse station is neat?

  • Bulletin boards are neat and not overloaded?

  • Defibrilators are checked while unplugged and documented per policy?

  • Patient care equipment is inventoried and checked by bio-med as indicated by attached inspection sticker?

  • Broken equipment is identified properly?

  • There are no expired blood tubes in Med Rooms/Storage Areas?

  • Open multi-dose vials are labeled with the expiration date?

  • There are no expired supplies in supply rooms?

  • There are no expired supplies or medications on crash carts or intubation boxes?

  • Dirty equipment is not stored in clean utility room / no clean equipment in dirty utility room?

  • Grab bars in patient restrooms are securely fastened?

  • Emergency call system in restrooms and showers are working properly?

  • There are no expired medications in Med Rooms/Pharmacy?

  • Information on communication boards in patient rooms, or at door comply with HIPAA?

  • Refrigerators are labeled properly for patient food or medication?

  • There are no open containers in patient refrigerators or freezers?

  • Food in refrigerator is marked/dated appropriately?

  • Required temperature logs are complete (equipment, refrigerator, etc.) ?

  • There is no medication or non-patient food items stored in pantry refrigerator?

  • No items are stored under sinks?

  • Additional Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.