Title Page

  • Document No.

  • Environment of Care - Maintenance

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 Previous Inspection

  • Has the last Inspection been reviewed?

  • No outstanding work orders?

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:

  • Fire extinguisher signs six feet off floor?

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

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

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

  • Exit doors open easily?

  • Miscellaneous

3.0 General Lighting

  • Lights working and in good condition?

  • Light lens cover in place and not damaged?

  • Egress lights working?

  • Exit lights working?

  • Miscellaneous

4.0 Building Maintenance

  • Base cove not loose,damaged or missing?

  • Hand rails not damaged or missing parts?

  • No visible wall damage?

  • Doors not damaged or missing parts?

  • Door locks and handles working correctly?

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

  • Signage not damaged or missing?

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

  • No water leaks?

  • Faucets shut-off completely, no drips?

  • Toilet does not leak and is properly sealed?

  • Plastic laminate in good condition?

  • Counter tops properly caulked?

  • Ceiling grid in good condition and intact?

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

  • Wall paper not torn or with loose seams?

  • Cabinet hinges and pulls in working condition?

  • Room conditions comfortable?

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

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

  • Exhaust grills secure and clean?

  • Thermostat/ sensor in good condition?

  • Supply and return grills in place?

  • Refrigerator / freezer seals and doors in good condition?

  • Is room air flow correct?

  • Room air flow correct.

  • Are exterior door air curtains working and clean?

  • Are ice machines clean and serviced on time?

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

  • Miscellaneous

5.0 General Housekeeping

  • Mechanical, electrical and communication rooms clean?

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

  • Miscellaneous

6.0 Mechanical Rooms

  • Are machine guards in place?

  • Drip pans in place and no spills?

  • Is lighting adequate?

  • Noise levels controlled?

  • Air ducts in good repair?

  • Are compressed gas bottles secured?

  • Miscellaneous?

7.0 Electrical Safety

  • No open "J" boxes?

  • Breaker box legends complete?

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

  • Portable equipment tested and tagged?

  • No broken plugs, sockets or switches?

  • GFIC and tamper resistant receptacles installed?

  • No extension cords in use?

  • No exposed wiring?

  • Line Isolation Monitor (LIM) cabinets unlocked?

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

  • 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.

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

  • Miscellaneous?

8.0 Ladders

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

  • Are ladders in good condition?

  • Are ladders properly secured?

9.0 Medical Gas

  • Medical gas alarms and zone valves labeled?

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

  • Are gauges working?

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

  • 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)

  • Miscellaneous

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