Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
EMS EOC Checklist
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Are all Housekeeping chemicals and solutions clearly identified?
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Are areas free of indications of any pest control concerns?
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Are dispensers clean and properly stocked with supplies?
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Are doors secured on clean and soiled linen rooms? Are carts covered?
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Are eyewash stations unobstructed by equipment or other items?
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Are floors clean, free of dust and dirt, with a high level of shine?
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Are furnishings clean, safe and in good repair? Are walls free of holes, scrapes patched and painted?
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Is flooring in need of repair or replacement?
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Are hand hygiene product dispensers with expiration date and filled?
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Are housekeeping closets, carts, and equipment clean and secured? Are products properly labeled?
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Are housekeeping closets, equipment and supply rooms clean, organized and adequately stocked?
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Are linen and trash chute rooms clean and properly functioning?
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Are personnel able to accurately describe the procedure for reporting a chemical spill and location of spill kits?
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Are personnel demonstrating proper procedures for handling regulated medical waste?
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Are receptacles for linen and trash in compliance not to exceed 32-gallon requirement?
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Are regulated medical waste and/or biohazard containers properly labeled, covered, stored, and secured?
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Are safety procedures being followed in linen and trash chute areas?
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Are vents, lights, and ceiling tiles free from dust, water stains, and mold?
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Are window treatments, privacy curtains, and shower curtains clean, hung, and properly maintained?
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Do staff have access to SDS sheets for all chemicals used in the department?