Title Page

  • Hospital
  • Department / Area Inspected

  • Department Director

  • Conducted on

  • Prepared by

  • Inspected By

Life Safety

  • Are exit doors and stairwells clear? Main, corridor, and stairwell exits cannot be blocked.

  • Are exit doors clearly marked "exit" and illuminated? Check for burned out bulbs.

  • Do fire doors latch properly? Close fire doors to see if they latch properly and see that there is no gap <1/8 inch in the middle.

  • Are corridors and passageways free of obstruction? The corridor can have mobile items (wheels on them) that are emergency needed items that are in use.

  • Are pull stations or fire extinguishers unobstructed? There must be nothing to obstruct access.

  • Are doors not propped open/held open? Doorstops or homemade held open devices are not allowed while no one is in the area. Tape is not allowed over any corridor doors.

  • Are all materials stored a minimum of 18" from sprinkler head?

  • Are storage rooms and equipment rooms free of clutter and unsafe conditions? Make sure items are not falling down or overstocked.

Safety Management

  • Is area free from evidence of smoking?

  • Are the floors/ hallways in good condition?

  • Are the walls not needing paint or repair?

  • Are any cables or wires not exposed?

  • Are ceiling tiles clean, stain free, and in good condition? Indicate where these bad tiles are located in the comments.

  • Are heavy items stored at low levels or mid levels in storage? Make sure the heavy items are stored at waist level or lower shelves.

  • Are general areas clean and free of clutter?

  • Are compressed gases stored properly? Compressed gases need to be chained to the wall or on a cart secured. Free standing bottles are not allowed.

Utilities

  • Are two prong extension chords removed from the area? These are the household type extension chords. Remove these immediately.

  • Are telephone chords out of the way?

  • Are all mechanical, electrical, janitorial, communications rooms clean with no storage? Indicate which rooms are not clean.

Infection Control

  • Are gloves, gowns, eyewear, and masks readily available?

  • Is clean linen covered?

  • Is clean linen kept separate from the dirty linen disposal?

  • Are refrigerator logs maintained and up to date in medicine and patient refrigerators?

  • Are medicines and food kept in separate refrigerators?

  • Are Sharps containers under 2/3 full?

  • Were employees eating or drinking in designated areas only? Staff should not have food or drinks in patient care areas.

  • Are there no items stored under the sink? Area under the sink must be locked.

Haz Mat & Waste

  • Is medical waste kept in red biohazard bags or containers?

  • Are secondary chemical containers labeled with product name, hazard label and manufacturer? Indicate any chemical that is in a container other than the original container.

  • Are chemicals stored separately from patient care contact or other clean items?

  • Is the Hazardous Chemical Inventory adequate and available to all employees? The hazardous chemical inventory list will be in the SDS book within the department.

  • Are appropriate procedures, instructions, or directions available for obtaining SDS? There should be instructions within the department to access the SDS.

Security

  • Is staff's personal items properly secured? Check for purses, billfolds, money, keys, etc. left out for you to take.

  • Are all employees wearing their ID badges in plain view?

  • Are all mechanical, electrical, janitorial, communications rooms locked? Indicate which rooms are not locked.

  • Are medications kept in locked rooms?

Medical Equipment

  • Does equipment not have any exposed wires? Check the plug for exposed wires.

  • Are all medical equipment tags current? Check all equipment for expiration dates. Leased equipment must also have been initially expected.

  • Does the equipment cleanliness, paint, wiring, and covers appear satisfactory?

  • The storage room doors will self close and latch? Ensure these doors are not propped open and close easily.

EOC Rounds Questions

Safety

  • Explain how to report an injury involving a staff member.

Security

  • Explain your response to a Code Silver.

  • Explain your response to a Code Pink.

Life Safety

  • What does RACE stand for?

  • Where is the nearest fire alarm pull station in your location?

  • Where is your nearest fire extinguisher?

Emergency

  • What is a Code Green?

  • Where are the MedSled Evacuation Sleds located?

Haz Mat and Waste

  • What goes into biohazard red bag waste?

Medical Equipment

  • How do you report a medical equipment problem?

  • Explain information found on the medical equipment sticker.

Utilities

  • If the power in the hospital fails, explain how to locate outlets powered by the emergency generator.

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