EOC Audit -

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. SAFETY/GENERAL SAFETY

• Warning signs or barricades are placed when work creates a hazard (wet floor, maintenance work in ceiling)?

  Yes

  No

  N/A

• All furniture and equipment is in sound condition? (no chipped or torn surfaces- no leaky faucets)

  Yes

  No

  N/A

• All wall-mounted devices (lights, TV’s, pictures, signs, containers, handrails, etc.) are secure and not loose?

  Yes

  No

  N/A

• Area is without clutter

  Yes

  No

  N/A

• Quality Control logs for Refrigerators/Freezers, freezers, and warmers are complete and corrective actions documented as appropriate?

  Yes

  No

  N/A

B. ELECTRICAL SAFETY

• No evidence of daisy chains

  Yes

  No

  N/A

• Items are not stored within 36" of an electrical panel?

  Yes

  No

  N/A

• Electrical cords, plugs, plates and switches are in good repair?

  Yes

  No

  N/A

• Extension cords only used temporarily but not on a permanent everyday basis?

  Yes

  No

  N/A

• The underside of beds and counters are free of electrical “wire nests” where feet could be entangled?

  Yes

  No

  N/A

C. MEDICATION/MEDICAL SUPPLIES

• Medications/medical supplies - have not passed expiration dates?

  Yes

  No

  N/A

• All syringes, basins, cups, containing medication or solutions are labeled with the name of the contents?

  Yes

  No

  N/A

• Supply area is clean?

  Yes

  No

  N/A

• Med Carts/Med Rooms are secured at all times?

  Yes

  No

  N/A

• Black boxes have been emptied and are not overflowing.

  Yes

  No

  N/A

• Samples are tracked per policy?

  Yes

  No

  N/A

• No boxes on the floor. All supplies 6 inched off the floor?

  Yes

  No

  N/A

• No items stored under the sink

  Yes

  No

  N/A

D. INFECTION PREVENTION

• Staff food is not stored in patient refrigerators?

  Yes

  No

  N/A

• Refrigerators/Freezers are clean, frost free, and labeled for type of storage with only those items present (no food and medication in the same refrigerator).

  Yes

  No

  N/A

• Refrigerators/Freezers contain thermometers and the refrigerator graphs are up-to-date? (thermometer should be located in the back)

  Yes

  No

  N/A

• No open or expired patient nourishment containers in refrigerator?

  Yes

  No

  N/A

• Ice machines are clean, no signs of deposits in tray or dispensing mechanism?

  Yes

  No

  N/A

• Anti-microbial soap and paper towels are available for hand washing?

  Yes

  No

  N/A

• Containers used for regulated or infectious waste are covered, leak proof, and clearly labeled as a biohazard?

  Yes

  No

  N/A

• Disposed sharps are in an approved container?

  Yes

  No

  N/A

• Sharps containers are secured in their holders, not accessible to residents and not more than three-fourths full?

  Yes

  No

  N/A

• Staff (including contracting physicians) perform hand hygiene?

  Yes

  No

  N/A

• Separation of clean and dirty?

  Yes

  No

  N/A

E. ENVIRONMENTAL

• Ceiling tiles clean and intact?

  Yes

  No

  N/A

• Floors free of dirt, dust and litter?

  Yes

  No

  N/A

• Ledges, walls and air vents free of dust?

  Yes

  No

  N/A

• Toilets and sinks secure and clean?

  Yes

  No

  N/A

• Privacy curtains clean and unsoiled?

  Yes

  No

  N/A

• Cove base is secured?

  Yes

  No

  N/A

F. HAZARDOUS MATERIALS

• Chemicals are properly labeled and secured?

  Yes

  No

  N/A

• How can you access Material Safety Data Sheets (MSDS)?

  Yes

  No

  N/A

• PPE is available?

  Yes

  No

  N/A

• Material Safety Data Sheets stickers are intact on phones?

  Yes

  No

  N/A

• Eye wash is flushed and logged?

  Yes

  No

  N/A

• Acids and bases stored separately?

  Yes

  No

  N/A

• Fume hoods have been certified?

  Yes

  No

  N/A

G. FIRE PREVENTION/ LIFE SAFETY

• Can you explain P.A.S.S. and what it stand for?

  Yes

  No

  N/A

• Staff know where the fire extinguishers and pull stations located in your department?

  Yes

  No

  N/A

• Confidential shred bins are compliant with NFPA Code

  Yes

  No

  N/A

• Halls/Corridors uncluttered and accessible?

  Yes

  No

  N/A

• Smoke detectors with 36" clearance from air supply to return?

  Yes

  No

  N/A

• Are the sprinkler heads free of dust?

  Yes

  No

  N/A

• Fire extinguisher (s) recently serviced? (monthly)

  Yes

  No

  N/A

• Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)

  Yes

  No

  N/A

• Eighteen-inch clearance from ceiling is maintained?

  Yes

  No

  N/A

• Are compressed gases stored in designated areas only and secured?

  Yes

  No

  N/A

• Are med gas valves labeled?

  Yes

  No

  N/A

• Are full and empty cylinders stored separately according to sign/labels?

  Yes

  No

  N/A

• All lights are working properly and flashlights with good batteries?

  Yes

  No

  N/A

• Flammable and hazardous materials properly stored and labeled?

  Yes

  No

  N/A

• Fire extinguishers and pull stations clear of obstructions?

  Yes

  No

  N/A

• Placement of Hand Sanitizer is not adjacent(with-in 6”) to a potential ignition source?

  Yes

  No

  N/A

• Egress path is clear of obstructions?

  Yes

  No

  N/A

• Soiled trash/linen carts do not exceed 32 gallons in a 64 sq. ft. area?

  Yes

  No

  N/A

H. EMERGENCY MANAGEMENT PROCEDURES

• Staff know the number to call to initiate an emergency response?

  Yes

  No

  N/A

I. SECURITY MANAGEMENT

• Staff know how to notify Security in a non-emergency?

  Yes

  No

  N/A

• Employees, volunteers, students, contracted staff, physicians, contractors and venders wearing ID badges?

  Yes

  No

  N/A

J. EQUIPMENT MANAGEMENT

• Staff know the procedures if a device/equipment does not work properly?

  Yes

  No

  N/A

• All medical equipment/devices has a current Bio-Medical sticker?

  Yes

  No

  N/A

• Equipment is clean?

  Yes

  No

  N/A

• Crash cart is locked, logs complete, oxygen is full?

  Yes

  No

  N/A

• Defibrillator is plugged in and charging?

  Yes

  No

  N/A

K. UTILITY MANAGEMENT

• Staff know what to do for a utility failure?

  Yes

  No

  N/A

• Staff know who is authorized to shut off medical gases?

  Yes

  No

  N/A

• Is correct air pressure maintained in critical environments? (Decontamination, soiled utility, scope rooms, etc.) per FGI 2010 guidelines.

  Yes

  No

  N/A

OR specific

• Hyperthermia cart is locked with log completed?

  Yes

  No

  N/A

• Staff know location of hyperthermia cart?

  Yes

  No

  N/A

• Sterilizer is clean and parameters are maintained?

  Yes

  No

  N/A

• Sterilizer has documented PM?

  Yes

  No

  N/A

• Sterilizer testing is up to date?

  Yes

  No

  N/A

• Temperature and humidity levels are checked daily. Temperature should not be lower than 68 and humidity cannot exceed 60%. Per FGI 2010 guidelines.

  Yes

  No

  N/A

Mechanical areas

• Floor is clean?

  Yes

  No

  N/A

• Power tools have guards in place?

  Yes

  No

  N/A

• PPE readily available?

  Yes

  No

  N/A

• 36" clearance maintained around electric panels?

  Yes

  No

  N/A

• Fall protection for areas above 6 feet high?

  Yes

  No

  N/A

• LOTO equipment readily available?

  Yes

  No

  N/A

• Isolation exhaust fans are labeled?

  Yes

  No

  N/A

Actions

• Preventive action is required?

  Yes

  No

• Preventive Action Plan:

• Corrective action is required?

  Yes

  No

• Cause of nonconformity

• Organizational corrective plan:

• Person/position responsible for implementation do corrective action

• Date for implementation of Plan

  Date

• Determine actions needed by observing:

• Results of. Actions taken:

• Review effectiveness

SIGN OFF

• Department/Unit Representative

  Sign

• Auditor

  Sign