Environment Of Care Rounds

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

INFECTION CONTROL PHYSICAL INSPECTION

• Are gloves, gowns,eyewear and masks readily available?

  Yes

  No

  N/A

• Is clean line covered?

  Yes

  No

  N/A

• Is clean linen kept separate from the dirty linen disposal?

  Yes

  No

  N/A

• Are refrigerator maintained and up to date in medicine and patient refrigerators?

  Yes

  No

  N/A

• Are sharps containers under 2/3 rd full?

  Yes

  No

  N/A

• We're staff eating or drinking in designated areas only?<br>(food in not permitted where cross contamination can occure)

  Yes

  No

  N/A

• Is there no storage under sinks?<br>(only cleaning supplies may be stored under sink)

  Yes

  No

  N/A

• Are all open nutritional supplements marked with an open date?<br>(these supplements are only good for 30 days after they are open)

  Yes

  No

  N/A

FIRE SAFETY PHYSICAL INSPECTION

• Are exit doors and stairwells clear and unobstructed?

  Yes

  No

  N/A

• Are exits clearly marked " EXIT" and fully illuminated?

  Yes

  No

  N/A

• Do fire doors latch properly?<br>(doors should have 3 point latching and have no more than 1/8 th inch gap between and 3/4 rd undercut)

  Yes

  No

  N/A

• Are corridors and passageways clear and unobstructed?<br>("IN USE" items are allowed in corridor when attended)

  Yes

  No

  N/A

• Are fire extinguishers, pull station and medical gas panels clear and unobstructed?

  Yes

  No

  N/A

• Are doors not propped/held open?<br>(door stops or other hold open devices are not permitted)

  Yes

  No

  N/A

• Are all material stored a minimum of 18" from sprinklers?

  Yes

  No

  N/A

• Are storage and equipment rooms free of clutter and unsafe conditions?

  Yes

  No

  N/A

SAFETY MANAGEMENT PHYSICAL INSPECTION

• Is area free from evidence of smoking or other tobacco use?

  Yes

  No

  N/A

• Are the floor/hallways in good /safe condition?

  Yes

  No

  N/A

• Are the walls not in need of repairs or painting?

  Yes

  No

  N/A

• Are the ceiling tiles clean, stain free and in good condition?

  Yes

  No

  N/A

• Are heavy items stored at low/mid levels to avoid lifting injuries and fall hazards?

  Yes

  No

  N/A

• Are general areas clean and free of clutter?

  Yes

  No

  N/A

• Are compressed gas cylinders stored properly?

  Yes

  No

  N/A

UTILITIES PHYSICAL INSPECTION

• Are 2 prong extension cords removed from area?<br>(this style cord is prohibited and should be removed immediately)

  Yes

  No

  N/A

• Are telephone cords out of the way?<br>(to avoid tripping hazards)

  Yes

  No

  N/A

• Are mechanical, electrical and communication closets clean and free of improper storage?

  Yes

  No

  N/A

HAZARDOUS MATERIAL & WASTE PHYSICAL INSPECTION

• Is medical waste kept in red biohazard bags and/or containers?

  Yes

  No

  N/A

• Is Regulated Medical Waste kept separate from normal trash?

  Yes

  No

  N/A

• Are secondary chemical containers labeled with product name, hazard label and manufacturer?

  Yes

  No

  N/A

• Are chemicals stored separately from patient contact or other clean patient items?

  Yes

  No

  N/A

• Are appropriate procedures, instructions or directions available for obtaining and using Material Safety Data Sheets (MSDS)?

  Yes

  No

  N/A

SECURITY PHYSICAL INSPECTION

• Is staff personal items properly secured? (purses, wallets, keys)

  Yes

  No

  N/A

• Are all employees wearing their ID badges in plain veiw?

  Yes

  No

  N/A

• Are all eye wash stations functional and clean?

  Yes

  No

  N/A

• Are all medications kept in a secured room?

  Yes

  No

  N/A

• Is all patient information (electronic or paper) kept secure?

  Yes

  No

  N/A

MEDICAL EQUIPMENT PHYSICAL INSPECTIONS

• Does equipment not have any exposed wire (including plug)?

  Yes

  No

  N/A

• Is inspection on all medical equipment current?

  Yes

  No

  N/A

• Does the equipment cleanliness, paint, wiring and cover appear satisfactory?

  Yes

  No

  N/A

• Are all warmers functioning and set at correct temperature?

  Yes

  No

  N/A

• Are all code/crash carts checked and logged per manufacturer's specifications?

  Yes

  No

  N/A

STAFF KNOWLEDGE QUESTIONS

• Staff knows what a "CODE TRIAGE" is?

  Yes

  No

  N/A

• Staff can explain what the Safety Committee is?

  Yes

  No

  N/A

• Staff know how/who to report defective equipment (medical/mechanical)?

  Yes

  No

  N/A

• Staff know how/who to report an accident or injury? Fill out an incident report?

  Yes

  No

  N/A

• Staff can speak to "National Patient Safety Goals?

  Yes

  No

  N/A

• Staff knows the location of the oxygen cut off valves? Who is responsible to turn them off?

  Yes

  No

  N/A

• Staff know the location of the MSDS book? How to obtain an MSDS?

  Yes

  No

  N/A

• Staff knows what a "CODE RED" is?

  Yes

  No

  N/A

• Staff can explain what R.A.C.E. means? What P.A.S.S means?

  Yes

  No

  N/A

• Staff knows the locations of nearest fire extinguishers? Fire alarm pull stations?

  Yes

  No

  N/A