Title Page
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Conducted on
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Prepared by
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Location
General Safety
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Corridors, fire exits and stairs are free from obstructions?
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Walls and ceilings are undamaged and free of stains?
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Flooring surfaces are: Intact, undamaged, clean and free of slip/trip hazards?
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Eyewash stations are operational and checked regularly?
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Emergency pull cords hang 4” off floor and are not wrapped around anything?
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Stored supplies are elevated off the floor with solid surface bottom shelving?
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Exit signs are illuminated?
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Lighting is suitable for area with fixtures lit properly?
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Work surfaces clean and undamaged?
Fire Safety
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Fire extinguishers are free of obstructions and have been inspected monthly/annually?
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Fire pull stations are easily accessible?
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Items are properly stored and are a minimum of 18” below ceiling height?
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Fire sprinkler heads have no ceiling obstructions, are undamaged and escutcheons have no gaps around them?
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Fire rated doors are correctly labeled, self closing, positive latching and not manually held open?
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Fire and fire/smoke walls have all penetrations sealed properly? Inspect a minimum of 3 locations.
Med Gas Safety
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Medical gas zone valves are properly labeled and unobstructed?
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Bulk med gas storage room is clean and all cylinders are secure?
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Portable gas cylinders are secured in carts, stands or chained to the wall?
Electrical Safety
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Extension cords are not in use?
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Power strips are not plugged into other power strips?
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Electrical, data and LV closets are clean with no storage?
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Electrical panels have schedule posted with no spare breakers in use?
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Are electrical outlets free from damage?
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Are GFCI outlets used in wet locations?
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Are tamper resistant outlets installed in waiting rooms?
Security
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Doors with extra security devices (card readers and keypads) are allowed to close and lock?
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Are personal items stored and kept out of sight?
