Carrasco Wellness Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• When is this inspection being conducted?

  Date

• Location:

General Housekeeping

• Is the facility clean and well kept?

  Yes

  No

  N/A

• Are the walls in good condition?

  Yes

  No

  N/A

• Is the ceiling in good condition?

  Yes

  No

  N/A

• Are the floors dry and in good condition?

  Yes

  No

  N/A

• Are the sheets kept clean for infirmary beds?

  Yes

  No

  N/A

• Are the restrooms clean?

  Yes

  No

  N/A

• Are vent fans functional?

  Yes

  No

  N/A

• Notes:

Electrical Safety

• Do electrical panels have 3ft clearance?

  Yes

  No

  N/A

• No exposed wiring?

  Yes

  No

  N/A

• Are light switches and outlet faceplates intact and secure?

  Yes

  No

  N/A

• Extension cords and power strips are in good condition and used correctly?

  Yes

  No

  N/A

• Do all lights have covers or sleeves?

  Yes

  No

  N/A

• Notes:

Fire Safety

• Are fire extinguishers present and in good condition?

  Yes

  No

  N/A

• Are flammables properly stored?

  Yes

  No

  N/A

• Are pull stations unblocked and accessible?

  Yes

  No

  N/A

• Are fire extinguishers clearly marked and unblocked?

  Yes

  No

  N/A

• Notes:

Evacuation Routes

• Are evacuation routes clear and easily accessible?

  Yes

  No

  N/A

• Are illuminated exit signs functional?

  Yes

  No

  N/A

• Are evacuation maps posted?

  Yes

  No

  N/A

• Notes:

Emergency Items

• Is emergency lighting functional?

  Yes

  No

  N/A

• Is the AED accessible and functional?

  Yes

  No

  N/A

• Are emergency exits marked and unblocked?

  Yes

  No

  N/A

• Are first aid kits available and stocked?

  Yes

  No

  N/A

• Notes:

Specialized Equipment

• Are x-ray machines secured and functional?

  Yes

  No

  N/A

• Are vaccines stored in a temperature controlled and secured environment?

  Yes

  No

  N/A

• Notes:

Medical Disposal and Safety

• Are one-time use items disposed of after use?

  Yes

  No

  N/A

• Are all medical instruments kept sterile?

  Yes

  No

  N/A

• Are sharp items disposed of in a designated sharps container?

  Yes

  No

  N/A

• Are staff trained on blood-borne pathogens and bio-contaminant disposal procedures?

  Yes

  No

  N/A

• Notes:

• Center Safety Officer:

  Sign