Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Safety Requirement
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Uninstructed fire exits, fire extinguishers, or pull stations.
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Storage no higher than 18" from a sprinkler head.
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Unobstructed electrical panels.
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Hallways clear.
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Gray bins for paper located in a room not in corridor.
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Hand rail is unobstructed.
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No doors propped open.
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No patient care items stored on floor.
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Food cart in dirty utility room.
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Bottom shelves on storage shelves have protective covering if open.
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All decorations meet policy requirements.
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Unobstructed fire/smoke doors.
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No space heaters in patient care areas.
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No fans in patient care areas.
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Staff know the evacuation route and the meeting point outside of the building.
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Fire doors closing and latching.
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Electrical cords and computer cable not a tripping hazard.
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Broken equipment properly labeled.
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Patient care equipment-preventive maintenance (PM) label not expired.
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Critical care equipment plugged into red outlets.
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Code carts checked and results documented daily.
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WOWs are dust free.
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Patient care equipment charging when not being used.
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Med and food refrigerator temps recorded daily; action documented on out of range temperatures.
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Open food in patient refrigerator labeled and dated.
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Refrigerator clean and defrosted.
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Housekeeping cart not left unattended.
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Sharps container less than 2/3 full.
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Med Rooms locked; unused sharps secured.
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Ceiling tiles in place and without stains.
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Alcohol gel containers not mounted over electrical outlets; not mounted within 6" of container.
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Hand hygiene being performed before and after contact with patient.
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Patient personal items or gloves not located under paper towel dispenser or soap dispenser on sinks in patient rooms.
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No outdated medications.
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All Multi-use medications dated when opened.
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No patient care items stored under sinks.
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All lighting working properly.
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All electrical outlets have covers.
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Personnel Protective Equipment (PPE) available for all staff.
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Proper isolation techniques being used by staff.
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Proper isolation signage used on patient doors.
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Ae additional glove boxes needed?
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No open food or drink at nursing station.
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All linen is covered.
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Chemicals labeled properly.
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Staff can find MSDS for hazardous materials in department.
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Staff know the location of spill kits and how to clean up a hazardous spill (if applicable).
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Is regular trash in biohazard bag?
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Oxygen tanks secured in a holder.
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Oxygen tanks transported in a holder not on a patient bed or stretcher.
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No more than 6 oxygen tanks in storage area.
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All chemicals and cleaners are labeled properly.
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Patient information secured and disposed properly.
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All staff wearing ID badges above waist.
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Staff know where to find safety and security policies.
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Staff know where to find the department specific emergency response plan and where to report in an emergency.
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Pharmaceutical waste guidelines being followed appropriately for vials with significant medication remaining.
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Empty medication vials in regular trash.
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Other Concerns Noted:
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Manager Signature: Date:
