Information
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Department
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Conducted on
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Prepared by
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Personnel involved
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Staff can explain RACE and PASS?
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Staff can locate the Emergency Preparedness Guide (Red Manual)?
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Evacuation Routes are clearly posted and accurate?
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Marked fire exits have clear path to outside?
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Patient Rooms and Office Doors are unobstructed and not propped open?
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Exit signs are visible and illuminated?
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Fire pulls and fire extinguishers are unobstructed?
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Fire extinguishers have monthly inspection and annual maintenance?
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Fire doors are unobstructed and latch and close properly?
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All smoke barrier penetrations properly sealed?
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Staff know their role in an emergency?
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Staff know where Power Outage supplies are located, and supplies are properly secured?
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Staff know who to call in the event of a utility failure?
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Staff can identify emergency power outlets?
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All equipment cords and plugs are in good repair?
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Full and empty Oxygen cylinders are properly stored and secured and area properly labeled?
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Staff know procedure for emergency oxygen shut-off?
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Med Gas shutoff (zones) are properly labeled?
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Staff know where eyewash stations are located?
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Eyewash stations are accessible and tested as warranted?
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Staff know where spill kits are located?
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All chemicals are stored appropriately and not left unattended?
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Staff know how to retrieve SDS?
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Chemical Inventory list is available and current?
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Biohazard rooms are clearly marked?
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Biohazard containers are covered and not overflowing?
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Equipment PM's are current?
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Life support equipment is plugged into appropriate emergency outlets?
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No extension cords in use?
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Lights are functional?
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No cracked/peeling paint or wallpaper?
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No holes in walls?
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Additional Comments