EOC Rounds - all templates

Full and empty oxygen or compressed gas cylinders are secured and are housed in proper storage area<br><br>EC.02.02.01 (EP 9) <br>CMS §482.41(d)(4) TAG: A-0726

No more than 12 oxygen cylinders stored per smoke compartment<br><br>EC.02.02.01 (EP 9) <br>EC.02.03.01 (EP1) <br>LS.02.01.30 (EP 2) <br>CMS §482.41(d)(4) TAG: A-0726; §482.41(b) TAG: A-0709; §482.41(b)(1)(ii) TAG: A-0710

All electrical power strips used with patient care devices are medical-grade; all cords are managed and organized so as not to increase risk of arcing, overheating, combustion or trip hazard. <br> <br> <br>EC.02.03.01 (EP 1) <br>LS.03.01.70 (EP 6) <br>CMS §482.41(b) TAG: A-0709; §482.41(b)(1)(ii) TAG: A-0710

3-prong electrical prongs are present <br> <br>EC.02.03.01 (EP 1) <br>LS.03.01.70 (EP 6) <br>CMS §482.41(b) TAG: A-0709; §482.41(b)(1)(ii) TAG: A-0710

Any portable heater or heat generating device, regardless of style, is prohibited.<br><br>EC.02.03.01 (EP 1) <br>LS.03.01.70 (EP 3) <br>CMS §482.41(b) TAG: A-0709; §482.41(b)(1)(i) TAG: A-0710 <br>St. Charles Policy #2048: General Electrical & Equipment Safety for Caregivers

No clutter of cardboard, files, boxes or paper is located under desks or work areas. No materials are stored on directly floor. <br><br>EC.02.06.01 (EP 1, 20) and IC.01.03.01 (EP 2) <br>CMS §482.41 TAG:A-700; §482.42(a)(3) <br>St. Charles policies #5089 & #8117 <br>Rationale: CDC - Best Practices for Environmental Cleaning in Healthcare Facilities: in Resource-Limited Settings

All trash and recycle containers are 32 gallons or smaller <br> <br>EC.02.03.01 (EP 1) <br>LS.03.01.70 (EP 6) (For full text, refer to NFPA 101-2012: 18/19.7.5.7.2 CMS §482.41(b) TAG: A-0709

All soiled linen or hazardous waste containers larger than 32 gallons, they are <br>located in a room protected as a hazardous area <br> <br>EC.02.03.01 (EP 1) CMS §482.41(b) TAG: A-0709

There is 18 inches or more of open space maintained below a sprinkler head<br><br>LS.03.01.35 (EP 6) <br>CMS §482.41(b) TAG: A-0709<br>NFPA 101, §9.7.1.1, §9.7.1.4, and §9.7.5; <br>NFPA 13, §8.6.6; <br>NFPA 25, §2-2.1.2

Exits are clear of obstructions or impediments to the public way, such as clutter, equipment, carts, furniture, construction material, snow, ice<br><br>LS.02.01.20 (EP 10-14) CMS §482.41(b) TAG: A-0709<br>NFPA 101 (18.2.3.4)

Access to alarms, electrical closets/panels, emergency shutoff valves, and fire extinguishers are clear of obstructions<br><br>LS.02.01.35 (EP 10) <br>CMS §482.41(b) TAG: A-0709 NFPA 101-2012: 20/21.3.5.3; 9.7.4.1 NFPA 10 section 6.1.3.1; annex D.2.3.1; annex F.7.2.2; NFPA 70, 110.32; <br>OSHA CFR 1910.303(g)(1)(i)(B)

The hospital prohibits all combustible decorations that are not flame retardant <br> <br>LS.02.01.70 (EP 5) <br>SCHS Policy #7933

IT closets and electrical rooms are inspected and free from penetrations or other fire code violations<br><br>LS.05.01.10 (EP 1-7) CMS §482.41(b)(1)(i) <br>(For full text, refer to NFPA 101-2012: 18/19.3.7.3; 8.2.3; 8.5.2; 8.5.6; 8.7)

Oxygen cylinders are stored securely and in appropriate rack?<br><br>EC.02.05.09 (EP 9 & 12) <br>CMS §482.41(d)(2) TAG: A-0724 <br>(For full text, refer to NFPA 99-2012: 5.1.3.1; 5.1.3.2.3; 5.2.3.1; 5.3.10; 11.3; 11.6.5.2.1)

Nothing suspended from the ceiling that could interfere with sprinkler system?<br><br>LS.03.01.35 (EP 5) <br>CMS §482.41(b)(1)(i) <br>(For full text, refer to NFPA 101-2012: 20/21.3.4.4; NFPA 25-2011: 5.2.1; 5.2.2; NFPA 13-2010: 6.2.6.2; 6.2.7.1)

All fire doors and/or frames are clearly marked with visible rating tags<br><br>LS.03.01.10 (EP 6) <br>CMS §482.41(b)(1)(i) <br>(For full text, refer to NFPA 101-2012: 8.3.3.2; 8.3.4.2; Table 8.3.4.2; 20/21.3.7.1; NFPA 80-2010: 5.2.13.3)

Soiled utility rooms are secured from public access <br> <br>LS.02.01.30 (EP 2); LS.02.01.70 (EP 6) <br>CMS §482.41(b)(1)(i) <br>(For full text, refer to NFPA 101-2012: 18/19.7.5.7) <br>(NFPA 101-2012: 18.3.2.1; 18.3.2.2; 18.3.2.3; 18.3.2.4; Table 18.3.2.1)

Chemicals, hazardous materials and waste are handled, stored, and disposed of <br>appropriately<br><br>EC.02.02.01 (EP 5) <br>CMS §482.41(a) TAG: A-0701; §482.41(b)(4) TAG: A-0713

Chemicals, hazardous materials and waste containers are correctly labeled <br>(example: spray bottles) <br> <br>EC.02.02.01 (EP 5) <br>CMS §482.26(b)(1) TAG: A-0536<br> §482.41(a) TAG: A-0701<br> §482.53(b) TAG: A-1035<br> §482.53(b)(2) TAG: A-1035

Sharps containers are securely anchored and are less than 2/3 full <br> <br>EC.02.02.01 (EP 5) <br>EC.04.01.01 (EP 8) <br>IC.01.02.01 (EP 3) CMS §482.41(a) TAG: A-0701 <br> §482.41(b)(4) TAG: A-0713 <br> §482.26(b)(2) TAG: A-0537 <br> §482.42 TAG: A-0747

Where necessary, Personal Protective Equipment (PPE) is available and is in working condition. <br> <br>EC.02.02.01 (EP 3, 5) <br>IC.02.01.01 (EP 2) <br>CMS §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951 <br> §482.26(b) TAG: A-0535<br> §482.26(b)(1) TAG: A-0536<br> §482.26(b)(3) TAG: A-0538<br> §482.41(a) TAG: A-0701<br> §482.53(b) TAG: A-1035

The physical environment (ceiling tiles, walls, floors, sinks, stairwells, etc.) is free of potential safety risks and damage, water, mold, etc. <br> <br>EC.02.06.01 (EP 1, 20, 26) <br>CMS §482.41 TAG: A-0700 <br> §482.41(a) - TAG: A-0701

The area is clean and free of offensive odors, and all furnishings and equipment are in good repair. <br><br>EC.02.06.01 (EP 20 & 26) <br>CMS §482.41 - TAG: A-0700 & §482.41(a) TAG: A-0701 <br>Rationale: CDC - Best Practices for Environmental Cleaning in Healthcare Facilities: in Resource-Limited Settings

The physical environment of any area providing patient care, treatment, or services provides enough lighting and the interior spaces accommodates the use of equipment, such as wheelchairs, necessary to the flow of daily activities. <br> <br>EC.02.06.01 (EP 20 & 26) CMS §482.41 TAG: A-0700 <br> §482.41(a) TAG: A-0701

The hospital takes action to maintain compliance with its smoking policy. Outside areas are free of any evidence of smoking. <br> <br>EC.02.01.03 (EP 6) <br>SCHS Tobacco Policy #3781 <br>ORS 433.835 – 433.990, The Oregon Indoor Clean Air Act (ICAA)<br>OAR 333 -015 – 0025 – 333 – 015 - 0990

All bathroom pull cords are free hanging within 12 inches from ground and are not tied to bar. <br> <br>OAR 333-535-0015 2018 Facility Guidelines Institute (FGI), Guidelines for Design and Construction of Hospitals/Outpatient Facilities <br>EC.02.06.01 (EP 1) CMS §482.41 TAG: A-0700<br> §482.41(a) TAG: A-0701

Grab bars and hand rails are secured to walls or fixtures. <br> <br>OAR 333-535-0015 2018 Facility Guidelines Institute (FGI), Guidelines for Design and Construction of Hospitals/Outpatient Facilities <br>EC.02.01.01 (EP 5) <br>CMS §482.41(a) TAG: A-0701

Area is free of possible trip, slip, and fall hazards. <br> <br>OSHA CFR 1910.22; 1910.28 <br>EC.02.01.01 (EP 3, 5) <br>CMS §482.13(c)(2) TAG: A-0144<br> §482.26(b) TAG: A-0535<br> §482.41(a) TAG: A-0701

All electrical, phone, and computer cords are secured and properly placed to reduce trip hazard.<br> <br>OSHA CFR 1910.22; 1910.28 <br>EC.02.01.01 (EP 3, 5) <br>CMS §482.13(c)(2) TAG: A-0144<br> §482.26(b) TAG: A-0535<br> §482.41(a) TAG: A-0701

Patient Handling powered equipment is plugged in when not in use. <br> <br>EC.02.04.03 (EP 2) <br>CMS §482.41(d)(2) TAG: A-0724

Department Disaster Plans are current and readily available. (Ask Caregiver a <br>question directly from their department specific disaster plan manual.) <br><br>EM.02.02.01 (EP 2) CMS Appendix Z - §482.15 & §485.625

Department Call Back List is current and accessible. <br> <br>EM.02.02.01 (EP 2) CMS Appendix Z - §482.15 & §485.625

Evacuation devices are securely anchored and are not obstructing exits or posing a safety risk. <br> <br>EM.02.02.03 (EP 9, 10) <br>LS.02.01.20 (EP 13) <br>CMS §482.15(a)(3) TAG: A----<br> §482.41(a) TAG: A-0701

Caregivers can verbalize an evacuation plan. <br> <br>EC.03.01.01 (EP 2) <br>EC.02.03.03 (EP 5) CMS §482.41(b)(1)(i) TAG: A-0710

Random staff members are questioned about what PPE to use when handling <br>hazardous materials. <br> <br>EC.02.02.01 (EP 3, 5) <br>IC.02.01.01 (EP 2) <br>CMS §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951 <br> §482.26(b) TAG: A-0535<br> §482.26(b)(1) TAG: A-0536<br> §482.26(b)(3) TAG: A-0538<br> §482.41(a) TAG: A-0701<br> §482.53(b) TAG: A-1035

Caregiver can verbalize how to appropriately respond during an emergency code. <br>(Ask a Caregiver how they call in and initiate a code appropriate for their <br>departments.) (Examples: Code Red, Code Orange, Active Weapon Threat) <br> <br>EC.03.01.01 (EP 2) <br>EC.02.03.03 (EP 5) CMS §482.41(b)(1)(i) TAG: A-0710

All spare breakers are turned off. <br> <br>EC.02.01.01 (EP 3) <br> CMS §482.13(c)(2) TAG: A-0144<br> §482.26(b) TAG: A-0535<br> §482.41(a) TAG: A-0701

Confidential Material and Protected Health Information are physically secured and <br>protected. <br> <br>45 CFR §160 §164 - The Health Insurance Portability and Accountability Act of 1996 (HIPAA) <br>EC.02.01.01 (EP 8) <br>IM.02.01.03 (EP 1,5) CMS §482.15(b)(5) <br> §482.13(d)(1) <br> §482.24(b) <br> §482.15(b)(5)

All employees, licensed independent practitioners, contractors, vendors, volunteers, <br>and visiting dogs are all wearing SCHS-approved ID badges. <br>(Numerator = # Compliant)<br>(Denominator = # Audits Done) <br> <br>EC.02.01.01 (EP 7) <br>§482.13(c)(2) TAG: A-0144

The hospital controls access to and from areas it identifies as security sensitive--all <br>secure areas are locked and/or secured. <br> <br>EC.02.01.01 (EP 8) <br>CMS §482.13(c)(2) TAG: A-0144<br> §482.53(b) TAG: A-1035

All fire and smoke doors close and latch properly. <br> <br>EC.02.03.01 (EP 1) <br>LS.02.01.30 (EP 12, 13, 20) CMS §482.41(b) TAG: A-0709

Fire extinguishers are checked monthly, are mounted, handles are placed 3 ½ - 5 <br>feet above the floor and secured, and are free from obstruction. <br>(Numerator = # Compliant)<br>(Denominator = # Audits Done) <br> <br>EC.02.03.05 (EP 15, 16) <br>CMS §482.41(d)(2) <br>OSHA - CFR 1910.157 <br>(For additional guidance, please see NFPA 10-2010: 7.1.2; 7.2.2; 7.2.4; 7.3.1)

Medical gas shutoff valves are not blocked. <br> <br>EC.02.05.09 (EP 2,) CMS §482.41(d)(2) TAG: A-0724

Each medical gas shutoff valve is clearly labeled and indicates which area the valve controls. <br> <br>EC.02.05.01 (EP 9)<br>EC.02.05.09 (EP 2) CMS §482.41(d)(2) TAG: A-0724 <br> §482.41(a) TAG: A-0701

All equipment critical to life and safety is plugged into Red Outlets. <br> <br>EC.02.05.03 (EP 5) <br>CMS §482.41(a)(1) TAG: A-0702

All fire resistant rating labels on fire and smoke doors are clearly legible. <br> <br>LS.02.01.10 (EP 9) CMS §482.41(b)(1)(i)

Eyewash stations are functioning properly and unobstructed. <br> <br>EC.02.02.01 (EP 5) <br>OSHA 29 CFR 1910.51 (also see: ANZI Z358.1) CMS §482.41(a) <br> §482.41(b)(4)

Under sink areas are free of supplies, equipment, and other items except cleaning supplies and vases. <br> <br>EC.02.06.01 (EP 26) <br>IC.01.03.01 (EP 2) <br>IC.02.01.01 (EP 1) <br>CMS §482.41 TAG: A-0700<br> §482.41(a) TAG: A-0701 <br> §482.13(c)(2) TAG: A-0144<br> §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951

There is no visible evidence of food consumption in patient care areas and all drinks are covered. <br> <br>EC.02.06.01 (EP 20) <br>IC.02.01.01 (EP 1) <br>CMS §482.41 TAG: A-0700<br> §482.41(a) TAG: A-0701 <br> §482.13(c)(2) TAG: A-0144<br> §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951

Supplies and equipment are not stored on the floor. <br>Supplies and equipment are stored on shelves at least 6 inches off the floor (8 inches in periop and central processing areas). Shelf liners are intact. <br> <br>IC.01.03.01 (EP 2) <br>EC.02.06.01 (EP 20 & 26) <br>SCHS policies #5089 & #8117 CMS §482.42 TAG: A-0747 <br> §482.41 - TAG: A-0700 & §482.41(a) TAG: A-0701 <br> <br>Rationale: CDC - Best Practices for Environmental Cleaning in Healthcare Facilities: in Resource-Limited Settings

Supply and Storage areas are clean and organized. <br> <br>IC.01.03.01 (EP 2) <br>EC.02.06.01 (EP 20 & 26) <br>NPSG.07.03.01 (EP 1) <br>SCHS policies #5089 & #8117 CMS §482.13(c)(2) TAG: A-0144<br> §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951 <br> <br>Rationale: CDC - Best Practices for Environmental Cleaning in Healthcare Facilities: in Resource-Limited Settings

Clean linen is covered. <br> <br>IC.02.02.01.4 <br>CMS §482.42 TAG: A-0747<br> §482.42(a) TAG: A-0748<br> §482.51 TAG: A-0940<br> §482.51(b) TAG: A-0951

Minumum distance of 16 inches between sinks and items storeed nearby OR splashguard is installed that provides the 16 inch coverage needed. <br> 42 CFR 482.42(a)(2) <br> IC.02.02.01 (EP 4) SCHS Policy #9272

Other Infection Control Issues Found

Other Infection Control Issues Found

Other Infection Control Issues Found

Describe in Notes

Describe in Notes

Describe in Notes

Describe in Notes

Describe in Notes