Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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First Aid Kit Complete?
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Are you using a Blood glucometer on the clients? If you are how is it being cleaned and calibrated?
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Emergency Equipment Up to date?
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Fire Drills up to date?
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Bathroom temps. Being taken and up to date?
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Medical supplies stocked?
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Keys and scan cards on site?
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Personal belongings stored properly?
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Is the emergency cell phone charged?
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AED is up to date and monthly checks completed?
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All storage rooms clean and organized?
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Extra client locker Keys?
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Nurse call light tested monthly.
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Laundry room temps.being taken and up to date.
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Dryer lint trap is clean?
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Process in place to clean dirty laundry basket and carts?
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Is the thermometer hanging up?
- Yes
- No
- N/A
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Washers are clean and laundry supplies full?
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Hot water tanks checked?
- Yes
- No
- N/A
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Towels and linens are inventoried?
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Medication refrigerator temps. Daily?
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Medication refrigerator calibrated monthly?
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Medical Equipment calibrated?
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Fire doors close and latch,no obstructions?
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No- non comprehensive chemicals in the building?
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Fire sprinkler heads are clean?
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Escutcheons secure to ceiling no more than 1/4" gap?
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Fire extinguishers unobstructed?
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Fire pulls unobstructed?
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All exit doors unobstructed?
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Linda Wyatt
