Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Safety Requirement

  • Uninstructed fire exits, fire extinguishers, or pull stations.

  • Storage no higher than 18" from a sprinkler head.

  • Unobstructed electrical panels.

  • Hallways clear.

  • Gray bins for paper located in a room not in corridor.

  • Hand rail is unobstructed.

  • No doors propped open.

  • No patient care items stored on floor.

  • Food cart in dirty utility room.

  • Bottom shelves on storage shelves have protective covering if open.

  • All decorations meet policy requirements.

  • Unobstructed fire/smoke doors.

  • No space heaters in patient care areas.

  • No fans in patient care areas.

  • Staff know the evacuation route and the meeting point outside of the building.

  • Fire doors closing and latching.

  • Electrical cords and computer cable not a tripping hazard.

  • Broken equipment properly labeled.

  • Patient care equipment-preventive maintenance (PM) label not expired.

  • Critical care equipment plugged into red outlets.

  • Code carts checked and results documented daily.

  • WOWs are dust free.

  • Patient care equipment charging when not being used.

  • Med and food refrigerator temps recorded daily; action documented on out of range temperatures.

  • Open food in patient refrigerator labeled and dated.

  • Refrigerator clean and defrosted.

  • Housekeeping cart not left unattended.

  • Sharps container less than 2/3 full.

  • Med Rooms locked; unused sharps secured.

  • Ceiling tiles in place and without stains.

  • Alcohol gel containers not mounted over electrical outlets; not mounted within 6" of container.

  • Hand hygiene being performed before and after contact with patient.

  • Patient personal items or gloves not located under paper towel dispenser or soap dispenser on sinks in patient rooms.

  • No outdated medications.

  • All Multi-use medications dated when opened.

  • No patient care items stored under sinks.

  • All lighting working properly.

  • All electrical outlets have covers.

  • Personnel Protective Equipment (PPE) available for all staff.

  • Proper isolation techniques being used by staff.

  • Proper isolation signage used on patient doors.

  • Ae additional glove boxes needed?

  • No open food or drink at nursing station.

  • All linen is covered.

  • Chemicals labeled properly.

  • Staff can find MSDS for hazardous materials in department.

  • Staff know the location of spill kits and how to clean up a hazardous spill (if applicable).

  • Is regular trash in biohazard bag?

  • Oxygen tanks secured in a holder.

  • Oxygen tanks transported in a holder not on a patient bed or stretcher.

  • No more than 6 oxygen tanks in storage area.

  • All chemicals and cleaners are labeled properly.

  • Patient information secured and disposed properly.

  • All staff wearing ID badges above waist.

  • Staff know where to find safety and security policies.

  • Staff know where to find the department specific emergency response plan and where to report in an emergency.

  • Pharmaceutical waste guidelines being followed appropriately for vials with significant medication remaining.

  • Empty medication vials in regular trash.

  • Other Concerns Noted:

  • Manager Signature: Date:

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