EMCM Environment of Care Rounds

• Document No.

• Audit Title

• Unit / Area

• Conducted on

  Date

• Prepared by

• Personnel

Building Exterior - Drives, Parking, Overall Campus

• Site lighting functioning properly?

  Yes

  No

  N/A

• Lighting turns on/off at appropriate times?

  Yes

  No

  N/A

• Parking lots are clear of debris / obstructions / tripping hazards?

  Yes

  No

  N/A

• Any standing water / ice in parking lots?

  Yes

  No

  N/A

• Appropriate signage to direct visitors / employees?

  Yes

  No

  N/A

• Signage visible at all times of day?

  Yes

  No

  N/A

• Campus fields are free of debris?

  Yes

  No

  N/A

• Are parking lots sufficiently salted / cleared during inclement weather?

  Yes

  No

  N/A

• Comments:

Building Interior

• Are entrances well lit?

  Yes

  No

  N/A

• Entrance doors function appropriately?

  Yes

  No

  N/A

• Air curtains functioning at building entrances?

  Yes

  No

  N/A

• Is there sufficient signage at entrances?

  Yes

  No

  N/A

• Are public restrooms easily indentifiable?

  Yes

  No

  N/A

• Any hot / cold spots in hospital?

  Yes

  No

  N/A

• Are public areas sufficiently lit / any bad lights?

  Yes

  No

  N/A

• Flooring is not chipped / torn / damaged?

  Yes

  No

  N/A

• Flooring is not wet / slick?

  Yes

  No

  N/A

• Any damages / scrapes / marks on walls?

  Yes

  No

  N/A

• Any visibly discolored ceiling tiles?

  Yes

  No

  N/A

• Interior doors function properly?

  Yes

  No

  N/A

• Is there sufficient interior signage directing public?

  Yes

  No

  N/A

• All elevators function properly?

  Yes

  No

  N/A

• Did elevators annunciate correctly?

  Yes

  No

  N/A

• Are fire alarms and extinguishers sufficiently signed and accessible?

  Yes

  No

  N/A

• Are fire exit plans sufficiently posted?

  Yes

  No

  N/A

• Where any audible alarms heard during stay / rounding- if so was there a response of the staff?

  Yes

  No

  N/A

• Comments:

Staff Narrative

• What was working well today?

• Are there specific areas that need attention and why?

• Are there any areas that should be recognized and what makes them notable?

• Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address resolve the issue?

• Is there anything we can do better?

Quarterly Focus

• Was a specific task being performed (i.e. cleaning, floors buffed, facility maintenance, equipment repair, transport, food delivered / picked up, elevators, etc.)?

• Did you identify anything that could affect the patient experience (lighting, signage, equipment making noise or rattling, loud talking, doors closing, etc)?

• Do you have any recommendations to improve the issues you identified?