Level One: Environmental Safety

Floors have no damage, stains, tripping or slipping hazards.

All surfaces, including furniture are intact and without chips, tears or cracks.

Department is clean/dust free

Plumbed eye wash stations are activated weekly for 2-3 minutes to flush the lines and ensure the stations are functioning safely and properly. The activation date is documented on the Eye Wash Inspection Log. Signage for the eye wash station is posted.

Ventilation grills are clean and unobstructed

Machine guarding is used appropriately (kitchen, shop)

Emergency Response Manuals are located in this department

No expired supplies. Process in place for checking expiration dates on a regular basis, including kits, carts and trays.

Personal items (purses, keys, phones) are stored out of sight

Doors with extra security devices such as card readers and keypads are always allowed to close and lock

Employees are wearing photo IDs appropriately, above the waist

Storage is at least 18” from ceiling. (Storage 5 inches is acceptable against the wall as long as there is no sprinkler head above it).

Cabinet doors and file drawers are kept closed when not in use.

Corridors and stairwells are clear, unobstructed, and well lit. There is no storage in stairwells or corridors

Walls and ceilings are free of major damage and stains

Level Two: Associated Safety

All fire extinguishers in the department have been inspected monthly and are fully charged.

Exit lighting is visible, lit and not damaged.

Fire doors latch shut and are not propped open or obstructed

Fire alarm pull stations and fire extinguishers are easily accessible. No storage with 36” of extinguishers/pull stations.

Elevator lobbies are clear, limited to furnishings equivalent to the size of 2 chairs

Egress corridors are free from combustible materials

Alcohol-based hand rubs are installed in accordance with the LSC:
• Dispensers are separated from each other by not less than 48”
• Dispensers do not leak
• Dispensers are not installed above electrical outlets

Electrical outlets are not damaged or loose, cover plates are on outlets

No items are stored within 36” of electrical closets or panels

Only hospital approved extension cords are in use and are not trip hazards or untidy (can be used up to 90 days—temporary use)

The outside of equipment and the power cords and plug have no visible damage (other than cosmetic) to include personal electric equipment.

Only approved space heaters are located in this area:
• No space heaters are allowed in patient care and sleeping areas
• Only Dayton Model 1VNY1 heaters are approved for non-patient areas
• Heaters are checked to be free of frayed cords, are shut off at night and are not located near combustible materials.
• Heaters that don’t meet these criteria are removed from the area and the department director is notified.

Locate Emergency Light Box with headlights, flashlights, check for batteries, etc

Area has a designated place for eating/drinking away from work area or any area where blood/body fluids are located.

Level 3: Patient Safety

Under sink storage is empty

Battery boxes are available in this area and used appropriately. Only lithium batteries are stored in the boxes.

Supplies stored a minimum 8 inches above the floor. Shelving has a solid bottom shelf with no openings.

Medical supplies are not stored in corrugated cardboard boxes. Supplies are stored in a clean area.

Storage bins for medical supplies are cleaning on a routine basis

Chemicals are properly labeled (need actual label, not handwritten on bottle, that includes the contents, appropriate hazard warning and the manufacturer’s name and address) and secured.

O2 /Air Tanks are stored properly, secured in carts or stands or chained to the wall – none are lying on the floor or unsecured.

Waste containers are available to separate paper and other trash (biohazardous waste, hazardous waste) and secured

Sterile item packaging is not compromised

Patient food refrigerator contents are appropriate, patient items are labeled. Perishable food items are dated and thrown when expired

Food storage or preparation does not occur in clean or dirty utility rooms

Refrigerators are specific for food-only , Staff-only or medication-only and are identified appropriately

Refrigerator temperatures are recorded and within normal limits. Freezers are defrosted regularly.
Refrigerators and freezers are not visibly soiled and are on a cleaning schedule. Storage of food, specimens and medications is appropriate.
Refrigerators with food:
Temperatures are documented 1-2 times per day and
are within 0-5 degree Centigrade (or 32- 41 degrees Fahrenheit)
Refrigerators with vaccines:
Temperatures are documented daily and
are in the 2-8 degree Centigrade range (or 36- 46 degrees Fahrenheit
Freezer Temperatures with food:
Temperatures are documented daily and are in -15 degree centigrade or below
Freezer Temperatures with vaccines:
Temperatures are documented daily and are in -15 degree centigrade or below

Vaccines refrigerators are monitored and logged appropriately.

No refilling of ultrasound gel is performed.

Playroom furniture and toys are checked for hazards and cleaned after use. Reading books and magazine are disposed of when damaged.

Level 4: Patient Safety

Crash Cart is checked daily, is in secured locations and is locked.

O2 tanks on Crash Carts have sufficient pressure.

Medications (vials, pills, patches, inhalers, eye drops, large volume IVs, etc.) are secured, not expired, not left unattended or accessible to the public and prepared in a clean area.

Medications are prepared in a clean area

Multiuse medications are dated appropriately.

Regulated medical waste containers are labeled and covered (red, black, and yellow containers) and secured.

Patient information in not left in public view (computer, white boards, charts, etc)

Needles or syringes are not left out or in unsecured drawers or cupboards. Sharps stored securely

Sharps Safety Exemptions are completed for non-safety needles

Clean linen is covered or stored in a dedicated enclosed cupboard with no other supplies or equipment. Contaminated laundry is transported and stored appropriately.

Electrical closets, soiled utility areas, and med rooms are kept locked

Handrails are present and secure in patient rooms, bathrooms and stairwells and not visibly soiled

Life support and critical equipment is plugged into solid red outlets

Medical gas shut offs are labeled correctly

Medical PMs are current

Patient alarms are set within identified parameters and are audible

Bathroom and shower call cords are between 4 and 8 inches off the floor and not visibly soiled

All reagents are dated when opened. Glucometers are free of contamination.

Personal protective equipment is readily available when appropriate i.e. Dirty utility room

Sinks and supplies are available where needed to provide for convenient hand hygiene by staff.

Appropriate isolation signs are used

Patient equipment is in good working order, no cracks/damage to equipment is noted

All reusable patient care items/equipment are cleaned/reprocessed appropriately.

Negative pressure rooms are monitored for negative pressure, and if negative pressure is lost, there is alarm that alerts staff.

Level 5: Immediate patient Safety

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.