Environment of Care - Maintenance

• Document No.

• Environment of Care - Maintenance

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 Previous Inspection

• Has the last Inspection been reviewed?

  Yes

  No

  N/A

• No outstanding work orders?

  Yes

  No

  N/A

2.0 fire Prevention

• Alcohol Based Hand Rub (ABHR) containers in proper location? One inch to the right, left and below ignition source. NFPA 101:19.3.2.6.

  Yes

  No

  N/A

• Fire extinguisher signs six feet off floor?

  Yes

  No

  N/A

• Is fire extinguisher four inches off floor and 60 inches to top of extinguisher? NFPA (2010) 6.1.3.8

  Yes

  No

  N/A

• Are "K" extinguishers properly labeled? NFPA (2010) 5.5.5

  Yes

  No

  N/A

• A restraining device is correctly installed on caster equipped natural gas appliances? NFPA 54 (2012) 9.6.1.2/ANSI Z223.1

  Yes

  No

  N/A

• Exit doors open easily?

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

3.0 General Lighting

• Lights working and in good condition?

  Yes

  No

  N/A

• Light lens cover in place and not damaged?

  Yes

  No

  N/A

• Egress lights working?

  Yes

  No

  N/A

• Exit lights working?

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

4.0 Building Maintenance

• Base cove not loose,damaged or missing?

  Yes

  No

  N/A

• Hand rails not damaged or missing parts?

  Yes

  No

  N/A

• No visible wall damage?

  Yes

  No

  N/A

• Doors not damaged or missing parts?

  Yes

  No

  N/A

• Door locks and handles working correctly?

  Yes

  No

  N/A

• Doors not held open by devices other than those that release when the door is pushed or pulled? NFPA 101 (2012) 18.3.6.3.10

  Yes

  No

  N/A

• Signage not damaged or missing?

  Yes

  No

  N/A

• Room description and ID number present? (AutoCad Department)

  Yes

  No

  N/A

• No water leaks?

  Yes

  No

  N/A

• Faucets shut-off completely, no drips?

  Yes

  No

  N/A

• Toilet does not leak and is properly sealed?

  Yes

  No

  N/A

• Plastic laminate in good condition?

  Yes

  No

  N/A

• Counter tops properly caulked?

  Yes

  No

  N/A

• Ceiling grid in good condition and intact?

  Yes

  No

  N/A

• Ceiling tile in good condition, not stained and not missing?

  Yes

  No

  N/A

• Wall paper not torn or with loose seams?

  Yes

  No

  N/A

• Cabinet hinges and pulls in working condition?

  Yes

  No

  N/A

• Room conditions comfortable?

  Yes

  No

  N/A

• Eye wash in correct position? 33-45 inches off floor and 6 inches from nearest obstruction. ANSI Z358.1

  Yes

  No

  N/A

• Sharps box at correct height? 50-56 inches off floor to opening.

  Yes

  No

  N/A

• Exhaust grills secure and clean?

  Yes

  No

  N/A

• Thermostat/ sensor in good condition?

  Yes

  No

  N/A

• Supply and return grills in place?

  Yes

  No

  N/A

• Refrigerator / freezer seals and doors in good condition?

  Yes

  No

  N/A

• Is room air flow correct?

  Yes

  No

  N/A

• Room air flow correct.

  Yes

  No

  N/A

• Are exterior door air curtains working and clean?

  Yes

  No

  N/A

• Are ice machines clean and serviced on time?

  Yes

  No

  N/A

• Nurse call cord 4 inches off floor but not more than 6 inches off floor? Is call cord cleanable?

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

5.0 General Housekeeping

• Mechanical, electrical and communication rooms clean?

  Yes

  No

  N/A

• Oily rags and combustibles in covered or closed metal containers?

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

6.0 Mechanical Rooms

• Are machine guards in place?

  Yes

  No

  N/A

• Drip pans in place and no spills?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

• Noise levels controlled?

  Yes

  No

  N/A

• Air ducts in good repair?

  Yes

  No

  N/A

• Are compressed gas bottles secured?

  Yes

  No

  N/A

• Miscellaneous?

  Yes

  No

  N/A

7.0 Electrical Safety

• No open "J" boxes?

  Yes

  No

  N/A

• Breaker box legends complete?

  Yes

  No

  N/A

• Flexible cords not run through ceiling tiles or doorways? NFPA 70 (2011) 400.8

  Yes

  No

  N/A

• Portable equipment tested and tagged?

  Yes

  No

  N/A

• No broken plugs, sockets or switches?

  Yes

  No

  N/A

• GFIC and tamper resistant receptacles installed?

  Yes

  No

  N/A

• No extension cords in use?

  Yes

  No

  N/A

• No exposed wiring?

  Yes

  No

  N/A

• Line Isolation Monitor (LIM) cabinets unlocked?

  Yes

  No

  N/A

• Electrical panels locked in public areas? NFPA 99(2012) 6.3.2.2.1.3

  Yes

  No

  N/A

• Power strips not used in patient care area. Special Purpose Relocatable Power Taps (UL 1363A or UL 60601-1) or Relocatable Power Taps (UL 1363) in use.

  Yes

  No

  N/A

• 36 inch clearance around electrical equipment and controls? NFPA 70 (2011) 110.26

  Yes

  No

  N/A

• Miscellaneous?

  Yes

  No

  N/A

8.0 Ladders

• Are ladders industrial strength? Non-household rated, check label.

  Yes

  No

  N/A

• Are ladders in good condition?

  Yes

  No

  N/A

• Are ladders properly secured?

  Yes

  No

  N/A

9.0 Medical Gas

• Medical gas alarms and zone valves labeled?

  Yes

  No

  N/A

• Do gauges have indicators with the normal pressure in the middle third of the range? NFPA 99 (2012) 5.1.8.1.3

  Yes

  No

  N/A

• Are gauges working?

  Yes

  No

  N/A

• Oxygen storage room with over 300 cubic feet has appropriate sign "Caution: Oxidizing Gas(es) Stored Within. No Smoking". NFPA 99 (2012) 11.3.4.2

  Yes

  No

  N/A

• Oxygen storage room with over 300 cubic feet has electrical fixtures five feet off the floor, a lockable door, one hour rated room, and cylinders secured from falling. NFPA 99 (2012) 5.1.3.3.2

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A