Information
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Audit Title
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Supervisor/Manager
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Conducted on
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Prepared by
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Contact Email
Unit Issues - Supervisor/Manager is responsible for correcting all “NO” answers in this Unit section. For any Procedural Changes with your environment (staff knowledge, improper storage, etc.) - Correct the situation AND Conduct applicable training to prevent re occurrence of noted issues.
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1) Are all commercial exhaust hoods inspected?
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2) Are space heaters the approved type, and in appropriate areas?
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3) Is all cooking equipment the proper type and in designated cooking areas?
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4) Are wet floors clearly marked with signage, to reduce slipping hazards?
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5) Is the area free of door chocks?
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6) Is the area free of electrical hazards (no damaged cords, extension cords or daisy-chaining surge protectors, etc.)?
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7) Are Relocatable Power Taps (power strips) the correct type in the correct locations? <br>RPTs must be listed UL 1363A or UL 60601-1 for patient care areas, <br>or UL 1363 for non-patient care equipment outside of patient care areas.
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8) Are medical inspection tags current?
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9) Are corridors and passageways free of obstructions?
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10) Are all stairwells clean, free of storage and obstructions?
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11) Are fire doors, fire extinguishers, gas cut-off valves and other emergency equipment unobstructed?
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12) Are fire and smoke doors free of posters and combustible decorations?
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13) Are all materials stored a minimum of 18 inches from sprinklers heads?
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14) Are Emergency Telephone Number stickers on telephones?
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15) Are the medications properly secured?
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16) Are trash rooms properly secured?
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17) Are storage & equipment rooms free of clutter and unsafe conditions?
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18) Are chemicals properly stored, labeled, and separated from patient contact/other clean items?
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19) Are chemical spill kits available?
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20) Is Chemical Inventory list updated annually and accessible to employees?
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21) Is Personal Protective Equipment available?
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22) Are all records maintained for weekly testing of eyewash units?
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23) Are the number of compressed gas cylinders within maximum limits?
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24) Are all compressed gas cylinders properly secured and segregated? (Green rack FULL, Red rack Used/Empty)
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25) Is the "Unit/Department Specific Emergency Preparedness Plan" complete, posted, and updated annually?
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26) Does staff know location and proper use of fire extinguishers?
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27) Does staff know location and proper use of medical gas shut-off valves?
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28) Do the employees observed have RACER & Identification cards?
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29) Does staff know how to report a lost Identification Card?
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30) Does the staff know how to access the Safety Manual and EOP?
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31) Does staff know how to access the SDS (Safety Data Sheet) for chemicals?
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32) Does staff know how to report an unsafe condition?
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33) Does staff know how to report safety and security incidents involving patients, visitors or staff?
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34) Does staff know how handle/report medical equipment malfunctions/incidents, including when someone is injured?
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35) Does staff know the roles & responsibilities of their specific unit/department during a disaster or emergency exercise?
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36) Does staff know of the emergency preparedness exercises that the facility has participated in the past 12 months?
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37) Have all Unit/Department concerns been addressed?
Life Safety Department / Plant Ops are responsible for correcting all "NO" answers in this section.
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38) Are hazards properly safeguarded for any renovations or construction projects underway?
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Are documents (construction & hot-works permits, barrier checklist, etc.) posted?
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39) Are all hazardous areas properly identified with signage?
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40) Are Exit and stairwell doors properly identified and illuminated?
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41) Are doors, including fire doors, in good repair and free to open, close and latch properly?
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42) Are sprinkler heads free from damage, corrosion, foreign materials and paint?
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43) Are all electrical panels free of open gaps and improperly connected breakers in panels?
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44) Are all panels in public areas properly secured?
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45) Are all mechanical/electrical areas free of combustible storage/debris?
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46) Are electrical outlets and junction boxes undamaged, and have covers?
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47) Is no smoking policy posted and being followed? Is the area free from evidence of smoking?
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48) Are all fire extinguishers inspected and tagged?
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49) Have fire drills been conducted and critiqued?
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50) Are there records of all required fire protection and detection systems’ inspections and tests?
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51) Have all facility concerns been addressed?
Appropriate Environment - Life Safety Department / Plant Ops are responsible for correcting all "NO" answers in this section.
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52) Is lighting suitable for the care, treatment, and services provided?
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53) Is the floor (tile / carpet) clean and in good condition?
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54) Are ceiling tiles and HVAC grilles clean and intact?
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55) Are electrical tamper-proof receptacles installed in the areas where children may be present?
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56) Are grab bars and handrails installed and in good condition, where required?
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57) Are all furnishing and equipment safe and in good repair?
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58) Are areas used by patients safe, clean, and free of offensive odors?
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59) Environment appropriate to the care, treatment, and services provided, in relation to the age & needs of patients?
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60) Is there an area for physicians or other healthcare professionals to speak to patients, visitors, or family that ensures privacy?
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61) Is the waiting area ADA compliant and located to minimize the impact of noise/activity on patient areas and staff functions?
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62) Are there adequate way-finding markings to assist patients and visitors in locating specific areas or service?
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63) Is the exterior of the building safe and free of hazards?
