Employee Health Location Assessment

• Employee Health Risk Assessment

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site Manager

• Photograph of Building

  Media

• Additional photograph

  Media

Specific workplace hazards

• Are any recognizable hazards present?

  No hazard present

  More than one but less than 4 present

  More than 4 hazards present

• Choose one or more as needed

  Select Lasers MRI Radiation - therapeutic Radiation - diagnostic Corrosive or harmful chemicals Chemotherapy Blood borne pathogens Airborne transmissible diseases Other

  • Lasers
  • MRI
  • Radiation - therapeutic
  • Radiation - diagnostic
  • Corrosive or harmful chemicals
  • Chemotherapy
  • Blood borne pathogens
  • Airborne transmissible diseases
  • Other

Routine Employee Health

• How are immunization booster services handled?

  By Employee Health

  In-house

  Unknown

• How are flu shots administered?

  By Employee Health

  In-house

  Unknown

• How is TB Testing done???

  By Employee Health

  In-house

  Unknown

Fire Prevention

• Fire doors close and latch?

  Yes

  No

  N/A

• Smoke doors close?

  Yes

  No

  N/A

• Doors wedged?

  Safe

  At Risk

  N/A

• Exit signs illuminated?

  Yes

  No

  N/A

• Fire alarms accessible?

  Yes

  No

  N/A

• Fire extinguishers accessible?

  Yes

  No

  N/A

• Flammables stored appropriately?

  Yes

  No

  N/A

• Medical gas stored appropriately?

  Yes

  No

  N/A

• Smoke detectors unobstructed?

  Yes

  No

  N/A

• Sprinklers unobstructed?

  Yes

  No

  N/A

• Appropriate use of decorations?

  Yes

  No

  N/A

Security Management

• Medications secured?

  Yes

  No

  N/A

• Syringes and needles secured?

  Yes

  No

  N/A

• Medical records secured?

  Yes

  No

  N/A

• Staff wearing IDs?

  Yes

  No

  N/A

• Belongings secured?

  Yes

  No

  N/A

Log Sheet Documentation

• OSHA Log?

  Maintained as required

  Present but not maintained

  No OSHA Log

• Crash carts - daily?

  Yes

  No

  N/A

• Refrigerators - daily?

  Yes

  No

  N/A

• Fire Extinguishers - monthly?

  Yes

  No

  N/A

Safety Management

• Electrical cords and plugs in a safe condition?

  Yes

  No

  N/A

• Extension cords are not in use?

  Yes

  No

  N/A

• GFI outlet within 6' of water source?

  Yes

  No

  N/A

• Electrical panels accessible (3')?

  Yes

  No

  N/A

• Corridors unobstructed?

  Yes

  No

  N/A

• Emergency reference guides available?

  Yes

  No

  N/A

• Flashlights available?

  Yes

  No

  N/A

• Lifting equipment available?

  Yes

  No

  N/A

• Stairwells clear?

  Yes

  No

  N/A

• Step stools available?

  Yes

  No

  N/A

• Yes

  No

  N/A

Utilities Management

• Building in good repair?

  Yes

  No

  N/A

• Ceiling tiles stained?

  Safe

  At Risk

  N/A

Clinical Equipment

• Current PM sticker?

  Yes

  No

  N/A

• Alarms disabled?

  Safe

  At Risk

  N/A

Hazardous Materials

• Appropriate use of utility rooms?

  Yes

  No

  N/A

• Sharps containers overfilled?

  Safe

  At Risk

  N/A

• PPE available?

  Yes

  No

  N/A

• Products properly labeled and stored?

  Yes

  No

  N/A

Infection Control

• Respiratory Hygiene Protocol in place?

  Safe

  At Risk

  N/A

• Hand-washing observed?

  Yes

  No

  N/A

• Linen covered?

  Yes

  No

  N/A

Waste Management

• Appropriate items in general trash?

  Yes

  No

  N/A

• Appropriate items in red bags?

  Yes

  No

  N/A

• Appropriate items in RCRA cans?

  Yes

  No

  N/A

• Appropriate items in sharps container?

  Yes

  No

  N/A

Recommended Follow-up?

• Follow-up for manager?

• Follow-up for Facilities?