• Department Surveyed

  • Type of Department

  • Frequency of Audit

  • Conducted on

  • Prepared by

  • Personnel

LIFE SAFETY MANAGEMENT – Brian Madsen, Interim Director of Engineering

  • Fire extinguishers unobstructed, in place, and inspection current.

  • Storage is 18” below all sprinkler heads. Work area uncluttered with proper egress.

  • Fire/Smoke separations are intact. Fire doors and Pt room doors close and latch properly.

  • Doors are not held open except by approved devices.

  • All exit signs are unobstructed and illuminated.

  • No equipment or supplies stored in stairwells or near fire doors.

  • Fire Wall Penetrations / Fire caulking

  • Alarms pull stations visible and accessible.

  • Staff Knowledge: What is the location of fire alarm pull stations and fire extinguishers? Where is your nearest fire alarm pull station and fire extinguisher located? Employees must know the location of their department's fire extinguisher and pull station without looking for it.

  • Staff Knowledge: Response to fire at point of origin (R.A.C.E. Rescue Alarm Contain Extinguish and P.A.S.S. Pull Aim Squeeze Sweep). How do you respond to a fire in you area? Rescue patients, visitors and staff in danger, Alarm the fire alarm system by using the nearest pull station. Contain the fire by closing doors (especially patient doors) Extinguish the fire. For use of an extinguisher: Pull safety pin from handle. Aim at the base of the fire. Squeeze handle. Sweep extinguisher hose from side to side at base of flame.

  • Response to CODE RED away from point of origin. How do you respond to a code red? Return to your department, clear corridors, close doors to patient rooms, obtain extinguishers and identify means of egress, reassure patients and visitors that their safety is our first priority.

  • Comments:

  • Signature upon completion of Audit

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