EMCM Safety Rounds

• Document No.

• Unit / Area:

• Conducted on

  Date

• Prepared by

• Personnel

General Safety Items:

• Egress routes / corridors are clear and uncluttered?

  Yes

  No

  N/A

• Ensure staff is aware of panic button in nursing station?

  Yes

  No

  N/A

• WOWS / COWS medical equipment in egress / routes corridors are moved in 30 minutes?

  Yes

  No

  N/A

• Oxygen is stored appropriately (no more than 12 cylinders per smoke compartment) and cylinders are secured in holders and racks?

  Yes

  No

  N/A

• Nothing is stored within 18 inches of fire sprinklers in all areas?

  Yes

  No

  N/A

• Electrical outlets are visibly functional (no blackened plugs, lacking covers, loose or broken covers)?

  Yes

  No

  N/A

• Nothing is stored / parked directly in front of electrical / medical gas panels?

  Yes

  No

  N/A

• Staff knows (RACE) and PASS for fire extinguishers?

  Yes

  No

  N/A

• Staff knows emergency code blue extension (ext. 2333)

  Yes

  No

  N/A

• Staff is aware of codes that may be called (Red, Blue, Yellow, Pink and Black)

  Yes

  No

  N/A

• Staff is clear on their roles if a code is called and how to report a safety and / or emergency concerns/issues (ext 6911)

  Yes

  No

  N/A

• Nonfunctioning medical equipment is reported to Biomed immediately

  Yes

  No

  N/A

• Red bag trash is labeled appropriately, emptied regularly and needle boxes are less than 3/4 full

  Yes

  No

  N/A

• Hazardous materials have MSDS available on MSDS online and are stored/labeled appropriately?

  Yes

  No

  N/A

• Doors are not propped open or locks disabled anywhere for any reason

  Yes

  No

  N/A

• Ceiling tiles do not have stains, cracks, missing or broken

  Yes

  No

  N/A

• Staff were not eating or drinking in designated work areas

  Yes

  No

  N/A

• Comments:

Staff Narrative

• What was working well today?

• Are there any specific areas that need attention and why?

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

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

• Is there anything we can do better?

Quarterly Focus

• Was a specific task being performed (I.e. codes, Biomed repairs, etc)?

• Did you identify anything that could affect the patient experience (I.e. medical equipment, outlets, red boxes, eating / drinking in work areas, etc.)?

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