Environment of Care

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

EOC Rounds

• Equipment in Corridors is in use and not stationary > 30 minutes?

  Yes

  No

  N/A

• Corridors and open alcoves are free from trash and linen carts?

  Yes

  No

  N/A

• Fire exit, cross-corridor and stairwell doors are equipped with panic hardware and self-closing devices (Close completely and automatically)?

  Yes

  No

  N/A

• Corridors, fire exits and stairwell are clear and unobstructed?

  Yes

  No

  N/A

• Exit signs are illuminated and at least two are always visible (all lights burning)?

  Yes

  No

  N/A

• Doors are held open only with magnetic hold open devices (no wedges, paper card boards, etc)?

  Yes

  No

  N/A

• "Stairs" signs are displayed at stairs entrances and elevators lobbies?

  Yes

  No

  N/A

• Corridor, cross-corridor and stairwell doors close and positive latching?

  Yes

  No

  N/A

• Electrical panels are locked and properly labeled?

  Yes

  No

  N/A

• No penetrations or separations in walls?

  Yes

  No

  N/A

• All light fixtures are protected, not damaged or burnt out?

  Yes

  No

  N/A

• There is no excessive trash or linen in the room?

  Yes

  No

  N/A

• All hazardous and proprietary doors are locked?

  Yes

  No

  N/A

• Biohazard signs on doors?

  Yes

  No

  N/A

• Biohazard bag usage acceptable?

  Yes

  No

  N/A

• Fire extinguishers have been checked monthly and have a current annual inspection tag?

  Yes

  No

  N/A

• Extinguishers less than 40 lbs must be no higher than 5 ft (measured from the floor to the top of the extinguisher), extinguishers greater than 40 lbs must be no higher than 3.5 ft (measured from the floor to the top of the extinguisher). Note: the clearance between the bottom of the extinguisher and the floor shall not be less than 4 inches?

  Yes

  No

  N/A

• No materials are blocking/hindering access to or hanging off the fire extinguisher, fire pull, or emergency shut off (3 foot rule)?

  Yes

  No

  N/A

• There are no materials stored within 18 inches of any sprinkler head or 12 inches of lights if non-sprinkled?

  Yes

  No

  N/A

• Storage area clean, free of dust and clutter?

  Yes

  No

  N/A

• Shelves and stored items off floor?

  Yes

  No

  N/A

• Extension cords are not in use?

  Yes

  No

  N/A

• Power strips are not plugged into power strips?

  Yes

  No

  N/A

• Electrical cords do not run under carpets, through walls or doors, or into cabinets?

  Yes

  No

  N/A

• All junction boxes, electrical switches and plugs must have covers (not broken)?

  Yes

  No

  N/A

• Appropriate bags are in use [red-biohazard, blue-recycle, yellow-chemotherapy]?

  Yes

  No

  N/A

• Sharps containers less than ¾ full?

  Yes

  No

  N/A

• Sharps container in appropriate rack or dog bowl on counter?

  Yes

  No

  N/A

• Appropriate disposal of fluid waste. [Solidifier or Hopper with protective glasses within reach]?

  Yes

  No

  N/A

• Eye wash stations operational and checked appropriately?

  Yes

  No

  N/A

• All portable gas cylinders in racks/stands and separated full/empty?

  Yes

  No

  N/A

• All rooms in the facility are numbered and labeled?

  Yes

  No

  N/A

• Area free of fall potentials?

  Yes

  No

  N/A

• All employees are wearing ID badges?

  Yes

  No

  N/A

• Ceiling tiles clean and undamaged?

  Yes

  No

  N/A

• Furnishings/pads, matresses safe and in good repair with no cuts?

  Yes

  No

  N/A

• Patient.OR/Treatment rooms free of dust/dirt/biohazard?

  Yes

  No

  N/A

• Do all clinical equipment items have current inspection tag?

  Yes

  No

  N/A

• Alternative waterless agent available and hung appropriately?

  Yes

  No

  N/A

• No items underneath sink and area dry/clean?

  Yes

  No

  N/A

• No cleaning agent accessible left unattended?

  Yes

  No

  N/A

• Work surfaces clean, free of dust, clutter and hazards?

  Yes

  No

  N/A

• Floors clean and free of clutter?

  Yes

  No

  N/A

• No environmental or personal heating devices?

  Yes

  No

  N/A

• Patient equipment found with no visible signs of soil of contamination?

  Yes

  No

  N/A

• Baseboards intact and in good repair?

  Yes

  No

  N/A

• Emergency pull cords hanging 6" from floor; no wrapping of cord around hand rail?

  Yes

  No

  N/A

• Floor tiles/vinyl in OR/flooring without evidence of cracks or seperation?

  Yes

  No

  N/A

• Type any special instruction, work requests, & calculated score:

• Inspectors Signature

  Sign