Facilities Management Zone Rounding

• Conducted on

  Date

• Prepared by

• Location

  Select Zone 1 (South Tower - 1st, 2nd, 3rd Floors) Zone 2 (Main Building - NSICU, Pharm, Operations, Lobby) Zone 3 (Main Building - CVICU, Surgical Services) Zone 4 (Main Building - ER, Rad, PT, 1 East, Rad Onc, Cardiac) Zone 5 (Main Building - 2nd & 3rd Floor) Zone 6 (All Roofs) Zone 7 (Exterior Grounds) Zone 8 (South Tower - 4th, 5th, 6th Floors)

  • Zone 1 (South Tower - 1st, 2nd, 3rd Floors)
  • Zone 2 (Main Building - NSICU, Pharm, Operations, Lobby)
  • Zone 3 (Main Building - CVICU, Surgical Services)
  • Zone 4 (Main Building - ER, Rad, PT, 1 East, Rad Onc, Cardiac)
  • Zone 5 (Main Building - 2nd & 3rd Floor)
  • Zone 6 (All Roofs)
  • Zone 7 (Exterior Grounds)
  • Zone 8 (South Tower - 4th, 5th, 6th Floors)

Ceiling Tiles/Grid

• Stained Ceiling Tiles?

  Yes

  No

  N/A

• Missing Tiles?

  Yes

  No

  N/A

• Gaps in Tiles?

  Yes

  No

  N/A

• Stained and/or Missing Grid?

  Yes

  No

  N/A

Lighting

• Debris in Light Fixtures?

  Yes

  No

  N/A

• Lights Not Working?

  Yes

  No

  N/A

Grills

• Dirty/Dusty Grills?

  Yes

  No

  N/A

• Unsecured Grills?

  Yes

  No

  N/A

• Broken Grills?

  Yes

  No

  N/A

Exit Signs

• Not Lit?

  Yes

  No

  N/A

• Unsecured Signs?

  Yes

  No

  N/A

• Visually Blocked Signs?

  Yes

  No

  N/A

Sprinkler Heads

• Dirty/Dusty Heads?

  Yes

  No

  N/A

• Gaps Around Head?

  Yes

  No

  N/A

Paint

• Patch Work Needed?

  Yes

  No

  N/A

• Touch-up Needed?

  Yes

  No

  N/A

• Whole Wall/Room Repainted?

  Yes

  No

  N/A

Wallpaper

• Peeling/Stained?

  Yes

  No

  N/A

Outlets

• Unsecured to Wall?

  Yes

  No

  N/A

• Plug Prongs Left Behind?

  Yes

  No

  N/A

• Missing Label?

  Yes

  No

  N/A

Handrail/Bump Rails

• Damaged Rail?

  Yes

  No

  N/A

• Missing Rail?

  Yes

  No

  N/A

• Needed Rail?

  Yes

  No

  N/A

Signage/Art

• Damaged Art/Sign?

  Yes

  No

  N/A

• Missing Art/Sign?

  Yes

  No

  N/A

Frame

• Unsecured Frame?

  Yes

  No

  N/A

• Missing Latch Plate?

  Yes

  No

  N/A

Slab

• Broken Slab

  Yes

  No

  N/A

• Missing Laminate (Exposed Core)?

  Yes

  No

  N/A

Door Hardware

• Handle/Hinges/Closer Not Working?

  Yes

  No

  N/A

Access Control/Door Operator

• Damaged Hardware?

  Yes

  No

  N/A

• Missing Hardware?

  Yes

  No

  N/A

Flooring

• Missing/Damaged Flooring

  Yes

  No

  N/A

Expansion Joints

• Missing/Damaged Gaskets

  Yes

  No

  N/A

Cove Base

• Missing/Damaged Cove Base

  Yes

  No

  N/A

Transition Strips

• Missing/Damaged Strips

  Yes

  No

  N/A

Slips/Trips Hazards

• Describe:

  Yes

  No

  N/A

Bathrooms

• Toilets (Describe the Issue)

  Yes

  No

  N/A

• Sinks (Describe the Issue)

  Yes

  No

  N/A

• Dispensers (Describe the Issue)

  Yes

  No

  N/A

Patient Rooms

• Headwall Equipment (Describe the Issue)

  Yes

  No

  N/A

• Phone (Describe the Issue)

  Yes

  No

  N/A

• Pillow Speaker (Describe the Issue)

  Yes

  No

  N/A

• TV (Describe the Issue)

  Yes

  No

  N/A

Surface Lots

• Potholes?

  Yes

  No

  N/A

• Drainage blocked?

  Yes

  No

  N/A

Sidewalks

• Cracks and/or Unsafe Elevations?

  Yes

  No

  N/A

Irrigation

• Improper Spraying?

  Yes

  No

  N/A

• Bad Head?

  Yes

  No

  N/A

• Exposed Sprinkler Lines

  Yes

  No

  N/A

Delineation

• Lines and/or Delineators Faded/Missing?

  Yes

  No

  N/A

Equipment

• Cones/Jersey Barriers/Powered Gates (Describe the Issue)

  Yes

  No

  N/A

Roofing Integrity

• Roof Breach?

  Yes

  No

  N/A

• Drains clogged?

  Yes

  No

  N/A

Safety Checks

• Debris that can be blown off of roof?

  Yes

  No

  N/A

• Wires and/or Trip Hazards Not Secured?

  Yes

  No

  N/A