Audit

Previous Inspections

Items from previous inspections have been addressed ?

Safety

Work/Storage Areas - safe and accessible (proper shelving used/secure, no above head hazards, heavier items on the bottom) ?

Work/Storage Areas - Clean and Clear (no excessive clutter) ?

Eye wash/shower station are tested weekly and documented?

Security

Staff, volunteers, vendors appropriately identified ?

Valuable items secured ?

Other

Hazardous Materials/Waste

Hazardous Chemicals - properly labeled/stored ?

Infectious Waste Containers (rigid, labeled, covered) ?

Infectious Waste Storage (Soiled Utility Rooms) - Doors to storage area closed/monitored or secured ?

Waste Disposal - Appropriate disposal of waste in proper container ?

Lead Aprons - Uniquely identified ?

Other

Emergency Preparedness

Emergency numbers posted (33333 on the phones) ?

Other

Fire Safety

Fire Doors - Not propped open (door wedges), Unit entrance doors - positively latch ?

Fire Exits - Clear, Correctly marked (Exit Signs), unlocked from inside, clear of debris/equipment ?

Sprinklers - 18" clearance ?

Fire Alarm/Pull Station - 3 ft. clearance ?

Oxygen/Gas Cylinders - Stored upright, secured on the top and bottom 3rd to prevent falling, in a stand/ cart, no more than 12 "E" cylinders per smoke compartment ?

Electrical Cords / strip outlets Not overloaded/daisy chained, In good repair, Extension cords not used ?

Fire Extinguishers Clearly marked, 3 ft. clearance, On wall or in cabinet, Pressure gauges read full ?

Appliances
- Major appliances (high wattage) plugged directly into a wall outlet, Clear from combustibles
- All appliances (especially those with a metal exterior) must have a three-prong plug (ground wire) to prevent fire and electrocution
- No hot-plates, fryers, hot air or easybake ovens, toasters, or toaster ovens allowed
- Microwaves are clean and free from loose debris inside and all vents are clear
- No open element space heaters
- Hot shots are clearly marked as 'hot, boiling water'

Ceiling tiles set in place properly and no gaps in the ceiling to allow smoke to enter ?

Other

Medical Equipment

Other

Physical Environment

Work/Storage Areas - Clean, Free from hazards/clutter ?

Floors/Walkways/Walls/Ceilings - In good condition, Clean, Dry, No penetrations, Adequate lighting, Construction-no signs of dust/debris ?

All items in storage are at least 4" off the floor

Other

Dietary / Nutrition

Refrigerators - Clean, Employee and Patient Food separated, Patient food labeled/dated, Temperature Logs current (for patient refrigerators only)?

Other

Infection Prevention

Staff eating or drinking in designated areas only ?

Hand gel/soap dispensers functioning and contain current product ?

Under sink storage clear (nothing allowed under sinks)?

Cubicle curtains are free of visible soil ?

Dirty linen storage - room secured?

Linen covered in (inside or outside of the clean utility room)?

Medication refrigerators log maintained (review follow up if temperatures were out of range)?

High Level Disinfection - Daily and QC logs complete?

Test Strips in a closed bottle and inside a cabinet?

Other

Utilities

Fixtures in good condition (no damage to outlets, outlet cover and light switches (char marks, cracks, discoloration ?)

Mechanical / Electrical / Communication rooms – clear of combustible material storage ?

Lights/Fixtures - covered/protected (diffusers not cracked or missing) ?

Med Gas Panel - 3 ft. clearance, Shut off zone identified ?

Electrical Panels - closed/covered, secured ?

Return / Supply air ducts in the ceiling clean (not covered with dust) ?

Appropriate areas (isolation rooms, toilets, soiled utility rooms, etc.) have negative pressure.

Other

Staff Knowledge

Reporting Accidents/Incidents ?

Back up/alternate communication systems ?

Code Pink ?

Code Gray ?

Hazardous Chemicals in the Area ?

Accessing SDSs ?

Code Violet ?

Code Red - RACE, PASS, Extinguisher/Fire Alarm Pull Station locations, Primary/Secondary Exits, Evacuation - horizontal/vertical ?

Oxygen Shut Off ?

Code Triage (Staff's role in a disaster - stand by and respond when/where needed) ?

Clinical Interventions for Equipment Failures ?

Utility Failure Procedures ?

How do you know if equipment is clean?

How and when to use the proper PPE?

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.