Environment of Care

Building / Maintenance

Ceiling tiles are in place, free from stains and unbroken.

No penetrations in the walls, floor or ceiling.

Wall hangings are secured.

Escutcheons are in place and properly seated.

Call pull cords are in appropriate locations, length, and unobstructed.

Exit signs are illuminated and unobstructed.

Egress route is unobstructed and proper width.

Stairwells are clear of items.

Smoke and fire doors latch, operate and close properly.

Approved surge protectors are used and are secured properly.

Fire extinguishers are properly labeled and inspected. Mounted between 5 inches from the floor and no more than 5 feet to the top of the extinguisher.

Furniture is clean and without stains, rips or tears.

Ice machines are clean. PMs are available.

Other

Other

Housekeeping / EVS

Floors are clean and free of slip hazards.

Windows and windowsills are clean.

Sharps containers are secured and less that 2/3rds full.

Clean linen is stored in a required area on shelves or carts, and is covered. No linen on the floor.

Clean and soiled linen are separated.

No excessive trash and linen in soiled utility.

Hand washing soap and/or sanitizer is available to staff.

Hand washing soap dispensers are operable and unbroken.

High level dusting has been preformed.

Vent grills are clean.

Area is free of insets, rodents and other vermin.

Housekeeping staff are aware of contact times for cleaning solutions.

Housekeeping staff are aware of the differences in patient isolation precautions.

Other

Other

Employee Safety / Department

Unoccupied patient rooms are clean and without used supplies.

No supplies under the sink.

Negative pressure rooms have appropriate air exchanges and are monitored.

Isolation precautions are appropriately posted and appropriate PPE is available.

Staff are knowledgeable in the differences in isolation precautions.

Adequate separation of clean and soiled equipment and storage.

Clean equipment is tagged and bagged according to policy. Process is consistent.

Soiled linen is bagged and placed in designated area.

Storage room supplies are 18" from the ceiling and at least 6" off the floor. Solid surfaces on the lower shelf of any shelving.

No cardboard boxes or supplies on the floor.

No corrugated boxes in nourishment area.

No expired items or supplies in the supply room.

Red biohazard bags/containers are available and only contain regulated waste items.

Sharps containers are easily accessible and unobstructed.

Sharps containers are not located above a waste can.

No capped syringes or medication vials in sharps containers.

No expired medications or IV solutions.

Medications are secured and not accessible to the public. Medications carts are locked.

Temperature logs on medication refrigerators are current and without missing entries.

Temperature logs on patient nourishment refrigerators are current and without missing entries.

Appropriate items stored in corresponding refrigerators. Patient and staff food not mixed.

Crash Cart logs are without missing inspections.

Medical Gas valves are not blocked.

Oxygen tank/cylinder storage is designated area. Full and in use cylinders are noted.

Other

Other

High Level Disinfection / Sterilization

Trophon HLD logs are up to date. Failures have action items.

Staff are knowledgeable on HLD process and process is consistent.

Ultrasound equipment is cleaned and disinfected according to manufacturers instructions for use.

Appropriate pre-cleaning or soaking/disinfecting solutions are available and used according to manufacturers guidelines.

Appropriate transport containers are used.

Sterilizer is functioning properly.

Sterilizer is cleaned and inspected regularly.

Chemical / Biological indicators are appropriate for process and are used per policy.

Scopes are sterilized according to manufacturers instructions for use.

Scopes are hung in closed cabinet and logged according to sterilization.

Appropriate PPE is available and used in decontamination area.

Decontamination room has separate hand washing sink.

Other

Other

Infection Prevention

Staff are aware of contact times for disinfectant wipes.

Disinfectant wipes are available and not expired.

Staff is knowledgeable on hand hygiene techniques. When to use soap and water versus sanitizer, and length of time for hand hygiene.

Staff is knowledgeable on the transport process of a patient on various isolation precautions.

PPE boxes are stocked appropriately.

Invasive lines (central lines, indwelling catheters, ventilation tubes, etc.) are documented appropriately.

Other

Other

Miscellaneous

Work space and desks are free from unnecessary clutter and food items.

Staff personal items are secured (i.e. purses/wallets).

Staff refrigerators are clean and labeled appropriately.

Hospital approved space heaters only are used.

No candles with fire burning wicks.

All cables and wires are neatly secured, out of the way of feet under a desk or work area.

Eye wash stations available in appropriate places and logged per policy.

Code knowledge (disaster, fire, evacuation, etc.) are demonstrated by staff.

Other

Other

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.