Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Ceiling tiles are in place, not stained, cracked, or broken.
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Sprinkler escutcheon are in plance and properly seated.
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Are lights working properly?
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Are cables and wire neatly secured and out of the way under desks and work areas?
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Are power strips / surge suppressors mounted above the floor?
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Is storage < 18 below sprinkler heads?
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Are alcohol foam hand sanitizer dispensers installed in the proper locations?
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Are floors clean and free of slip hazards?
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Are needle / sharp boxes full?
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Are construction barriers properly sealed to limit spread of dust and smoke?
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Are all patients sleeping room doors unobstructed (doors can close & latch)?
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Are corridors clear of non-movable items and all carts on one side of corridor?
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Are fire extinguishers & hose cabinets unobstructed?
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Are fire extinguisher inspections current?
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Are doors / doorframes free of written combination for push-button security locks?
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Are doors in egress routes locked?
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Are childproof outlets installed in pediatric areas and public areas (waiting rooms, public hallways, etc)?
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Are walls free from holes?
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Are all compressed gas tanks secured in a rack or holder?
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Are all smoke & fire doors unobstructed?
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Do all smoke & fire doors latch & close properly (top, bottom, and center)?
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Are all areas / rooms (fixtures/surfaces, vents) clean and free of dust accumulation?
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Is the gap on all fire / smoke doors < 1/8 between doors?
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Are all doors free of wedges and obstructions (waste baskets, etc.)?
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Are all stairwells free of stored items and no penetrations in walls?
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Is emergency equipment connected to red outlets?
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Are clean / dirty supplies, equip., etc. appropriately separated in utility rooms?
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Are EXIT signs illumination working?
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Is the Emergency Egress route clearly marked?
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Are stairwell passage lights working?
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Are MEDGAS (O2, vacuum, etc) valves unobstructed by equipment / carts and appropriately labeled?
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Are all electric breaker boxes locked?
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Are all employees, physicians and contractors wearing ID Badges?
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Are all chemicals/containers labeled?
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Is there excessive trash and linen in soiled utility rooms?
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Are medical equipment tags current on all required unit equipment?
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Are any clinical alarms silenced, muffled (tape/gauze) or turned off?
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Are any door latches taped or stuffed to prevent latching?
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Are there > 12 compressed gas cylinders Stored in any single smoke compartment?
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Additional Comments.
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