Audit

Add location

1. Fire Extinguishers inspected and tags initialed monthly

fire extinguisher

Compliance Score

Correction plan:

Target completion date

2. Fire doors functional and unobstructed

fire doors

Compliance Score

Correction plan:

Target completion date

3. Exits and entrances clear and marked

exits and entrances

Compliance Score

Correction plan:

Target completion date

4. Hallways and corridors clear

hallways and corridors

Compliance Score

Correction plan:

Target completion date

5. Stairs and stairways clear

stairs and stairways

Compliance Score

Correction plan:

Target completion date

6. Storage (e.g, clean and uncluttered, 18" clear in sprinkled areas, clean storage houses clean items only)

storage

Compliance Score

Correction plan:

Target completion date

7. No Internal Storage of flammables

storage of flammables

Compliance Score

Correction plan:

Target completion date

8. Storage of gas cylinders (chained to wall or secured in carrier), not in violation of storage requirements

storage of gas cylinders

Compliance Score

Correction plan:

Target completion date

9. Rolling items clean and in good repair (e.g, carts, IV poles, wheel)

condition of rolling items

Compliance Score

Correction plan:

Target completion date

10. Medical records area lockable

medical records

Compliance Score

Correction plan:

Target completion date

11. Work surfaces clean

work surfaces

Compliance Score

Correction plan:

Target completion date

12. Smoking regulations enforced

smoking regulations

Compliance Score

Correction plan:

Target completion date

13. Safety Manual/Environment of Care Manual in place with required policies and Material Safety Sheets (MSDS)

manuals

Compliance Score

Correction plan:

Target completion date

14. Refrigerator/freezer temperature checks current

refrigerator and freezer

Compliance Score

Correction plan:

Target completion date

15. Expiration dates checked (mess,food,supplies)

expiration dates

Compliance Score

Correction plan:

Target completion date

16. Personal protective equipment available

protective equipment

Compliance Score

Correction plan:

Target completion date

17. Emergency exit signs and lighting tested for 30 seconds

exit signs

Compliance Score

Correction plan:

Target completion date

18. Syringes/needles in secured Sharps Container

sharps container

Compliance Score

Correction plan:

Target completion date

19. Eyewash station available and unobstructed

eyewash station

Compliance Score

Correction plan:

Target completion date

20. Ceiling tile not stained or dirty

ceiling tile

Compliance Score

Correction plan:

Target completion date

21. UA specimens stored in refrigerator free from patient contact, separate from clean areas, and labeled bio-hazardous

UA storage

Compliance Score

Correction plan:

Target completion date

22. UA specimen refrigerator is labeled bio-hazardous

UA storage

Compliance Score

Correction plan:

Target completion date

23. Hand-washing facilities readily accessible (I.e, easy access, soap dispenser present and functional, paper towels present)

hand washing facilities

Compliance Score

Correction plan:

Target completion date

24. Sharps containers are located as close as possible to where sharps are used

sharps containers

Compliance Score

Correction plan:

Target completion date

25. Sharps containers are not overfilled and replaced routinely

sharps containers

Compliance Score

Correction plan:

Target completion date

26. Sharps containers contain appropriate materials (i.e, no gloves, gauze, tubing)

sharps containers

Compliance Score

Correction plan:

Target completion date

27. All chemicals are properly labeled with names and hazard identified

chemical labeling

Compliance Score

Correction plan:

Target completion date

28. Patient care items not stored under sinks

patient items storage

Compliance Score

Correction plan:

Target completion date

29. Not able to overhear any patient information in public areas (e.g, elevators, cafeteria, no clinical areas)

patient information

Compliance Score

Correction plan:

Target completion date

30. Not able to observe information on an unattended computer screen

patient information

Compliance Score

Correction plan:

Target completion date

31. Not able to see unattended patient-identifiable information while in area (e.g, copies of medical record

patient information

Compliance Score

Correction plan:

Target completion date

32. Not able to find any patient-identifiable information in trash cans

patient information

Compliance Score

Correction plan:

Target completion date

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.