Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Ceiling tiles are in place, not stained, cracked, or broken.

  • Sprinkler escutcheon are in plance and properly seated.

  • Are lights working properly?

  • Are cables and wire neatly secured and out of the way under desks and work areas?

  • Are power strips / surge suppressors mounted above the floor?

  • Is storage < 18” below sprinkler heads?

  • Are alcohol foam hand sanitizer dispensers installed in the proper locations?

  • Are floors clean and free of slip hazards?

  • Are needle / sharp boxes full?

  • Are construction barriers properly sealed to limit spread of dust and smoke?

  • Are all patients sleeping room doors unobstructed (doors can close & latch)?

  • Are corridors clear of non-movable items and all carts on one side of corridor?

  • Are fire extinguishers & hose cabinets unobstructed?

  • Are fire extinguisher inspections current?

  • Are doors / doorframes free of written combination for push-button security locks?

  • Are doors in egress routes locked?

  • Are childproof outlets installed in pediatric areas and public areas (waiting rooms, public hallways, etc)?

  • Are walls free from holes?

  • Are all compressed gas tanks secured in a rack or holder?

  • Are all smoke & fire doors unobstructed?

  • Do all smoke & fire doors latch & close properly (top, bottom, and center)?

  • Are all areas / rooms (fixtures/surfaces, vents) clean and free of dust accumulation?

  • Is the gap on all fire / smoke doors < 1/8” between doors?

  • Are all doors free of wedges and obstructions (waste baskets, etc.)?

  • Are all stairwells free of stored items and no penetrations in walls?

  • Is emergency equipment connected to red outlets?

  • Are clean / dirty supplies, equip., etc. appropriately separated in utility rooms?

  • Are EXIT signs illumination working?

  • Is the Emergency Egress route clearly marked?

  • Are stairwell passage lights working?

  • Are MEDGAS (O2, vacuum, etc) valves unobstructed by equipment / carts and appropriately labeled?

  • Are all electric breaker boxes locked?

  • Are all employees, physicians and contractors wearing ID Badges?

  • Are all chemicals/containers labeled?

  • Is there excessive trash and linen in soiled utility rooms?

  • Are medical equipment tags current on all required unit equipment?

  • Are any clinical alarms silenced, muffled (tape/gauze) or turned off?

  • Are any door latches taped or stuffed to prevent latching?

  • Are there > 12 compressed gas cylinders Stored in any single smoke compartment?

  • Additional Comments.

  • name

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