Information
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Department Audited:
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Type of Department
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Frequency of Audit
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Conducted on
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Prepared by
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Personnel
UTILITIES MANAGEMENT – Brian Madsen, Interim Director of Engineering
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All medical equipment provided with hospital grade plugs or equivalent.
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Nothing stored within 18” of sprinkler heads.
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No obvious penetrations in walls/ceiling.
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Mobile Equipment to one side of hallway only.
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Medical gas shut off valves with distribution labels.
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Oxygen cylinders in holders – not laying/standing on floor.
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Non-approved electrical equipment removed from area.
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Electrical Panels locked and not blocked by any devices or equipment
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No extension cords used within department and surge protectors used properly with approved devices
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Staff Knowledge: Location of gas shut-off valves and procedure to follow in an emergency. Where are your gas shut off valves? When might you need to shut off the gas? How would you do it? Appropriate staff must identify shut-off valve location without searching for it; explain circumstances when gas might need to be shut off, proper precautionary measures for patients and procedures for shutting off gas. If a need arises and a department Director feels the need to shut-off a gas shut-off valve they must contact Engineering and explain the circumstances. From there, Engineering will make a determination as to if the gas shut-off valves. Employees need to know this information so that in the event of an emergency this information can be shared with or provided to Emergency personnel such as the Fire Department, Police Department, Engineering Department, etc. Employees are not turn-off shut-off valves without the permission of Engineering, Respiratory, or the House Supervisor.
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Comments:
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Signature upon completion of Audit
