Information

  • Employee Health Risk Assessment

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Site Manager

  • Photograph of Building

  • Additional photograph

Specific workplace hazards

  • Are any recognizable hazards present?

  • Choose one or more as needed

Routine Employee Health

  • How are immunization booster services handled?

  • How are flu shots administered?

  • How is TB Testing done???

Fire Prevention

  • Fire doors close and latch?

  • Smoke doors close?

  • Doors wedged?

  • Exit signs illuminated?

  • Fire alarms accessible?

  • Fire extinguishers accessible?

  • Flammables stored appropriately?

  • Medical gas stored appropriately?

  • Smoke detectors unobstructed?

  • Sprinklers unobstructed?

  • Appropriate use of decorations?

Security Management

  • Medications secured?

  • Syringes and needles secured?

  • Medical records secured?

  • Staff wearing IDs?

  • Belongings secured?

Log Sheet Documentation

  • OSHA Log?

  • Crash carts - daily?

  • Refrigerators - daily?

  • Fire Extinguishers - monthly?

Safety Management

  • Electrical cords and plugs in a safe condition?

  • Extension cords are not in use?

  • GFI outlet within 6' of water source?

  • Electrical panels accessible (3')?

  • Corridors unobstructed?

  • Emergency reference guides available?

  • Flashlights available?

  • Lifting equipment available?

  • Stairwells clear?

  • Step stools available?

Utilities Management

  • Building in good repair?

  • Ceiling tiles stained?

Clinical Equipment

  • Current PM sticker?

  • Alarms disabled?

Hazardous Materials

  • Appropriate use of utility rooms?

  • Sharps containers overfilled?

  • PPE available?

  • Products properly labeled and stored?

Infection Control

  • Respiratory Hygiene Protocol in place?

  • Hand-washing observed?

  • Linen covered?

Waste Management

  • Appropriate items in general trash?

  • Appropriate items in red bags?

  • Appropriate items in RCRA cans?

  • Appropriate items in sharps container?

Recommended Follow-up?

  • Follow-up for manager?

  • Follow-up for Facilities?

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