Information

  • Department

  • Conducted on

  • Prepared by

  • Personnel involved

  • Staff can explain RACE and PASS?

  • Staff can locate the Emergency Preparedness Guide (Red Manual)?

  • Evacuation Routes are clearly posted and accurate?

  • Marked fire exits have clear path to outside?

  • Patient Rooms and Office Doors are unobstructed and not propped open?

  • Exit signs are visible and illuminated?

  • Fire pulls and fire extinguishers are unobstructed?

  • Fire extinguishers have monthly inspection and annual maintenance?

  • Fire doors are unobstructed and latch and close properly?

  • All smoke barrier penetrations properly sealed?

  • Staff know their role in an emergency?

  • Staff know where Power Outage supplies are located, and supplies are properly secured?

  • Staff know who to call in the event of a utility failure?

  • Staff can identify emergency power outlets?

  • All equipment cords and plugs are in good repair?

  • Full and empty Oxygen cylinders are properly stored and secured and area properly labeled?

  • Staff know procedure for emergency oxygen shut-off?

  • Med Gas shutoff (zones) are properly labeled?

  • Staff know where eyewash stations are located?

  • Eyewash stations are accessible and tested as warranted?

  • Staff know where spill kits are located?

  • All chemicals are stored appropriately and not left unattended?

  • Staff know how to retrieve SDS?

  • Chemical Inventory list is available and current?

  • Biohazard rooms are clearly marked?

  • Biohazard containers are covered and not overflowing?

  • Equipment PM's are current?

  • Life support equipment is plugged into appropriate emergency outlets?

  • No extension cords in use?

  • Lights are functional?

  • No cracked/peeling paint or wallpaper?

  • No holes in walls?

  • 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.