Title Page
-
Site conducted
-
Date
-
Inspecting Officer
-
Location/Station
-
Shift
Exterior
-
Yard Cut and Trimmed
-
Beds Mulched, Weeded and Neat
-
Shrubbery Trimmed and Neat
-
Parking Lot & Ramps Clean
-
Misc. Items Stored Appropriately
-
Building in Good Repair
-
Exterior Windows Clean
-
Security Lighting Works
-
Cipher Locks Work on Doors
-
Station Signage in Good Repair
-
Gas Grill-Clean/Stored Appropriately
-
Vehicles Parked in Spaces
-
Flag and Flagpole in Good Repair
-
Vehicles/trailers plugged into shore power as appropriate
-
Exterior Sheds and Trailers locked
Apparatus
-
Accountability Icons in Place
-
Apparatus Clean & Waxed (including trailers and utility vehicles stored outside)
-
Cabs & Patient Compartments Clean
-
Compartments Clean & Orderly
-
Check Sheets Up To Date
-
Tools/Equipment in Good Repair App. Within PM parameters (oil change, inspection, etc.)
-
EMS Medication Climate Control Units engaged and functioning properly
-
EMS Medication Cabinets Locked
Bay Floor
-
Floors Clean and Non-Slippery
-
Windows Clean & in Good Repair
-
Misc. Items Stored Appropriately
-
Parking Locations Clearly Striped
-
Walls Clean
-
Hose Dryer Clean
-
Ice Machine Clean & In Good Repair
-
Washer & Dryer in Good Repair
-
Misc Items Stored Properly/Neatly
-
Gear Lockers/Racks Orderly
-
Grill-Clean/Stored Appropriately
-
Bay Doors Operational
-
EMS Locker – Clean / Neat
-
LBBs – Clean / Stored Neatly
-
Power Tools Have Proper Guarding
Utility Rooms and Shops
-
Tile Floors Clean
-
Sinks Clean
-
Ice Machine Clean & In Good Repair
-
Work Benches Clean & Orderly
-
Tools Stored Appropriately
-
Supply Lockers Clean & Orderly
-
Misc Items Stored Appropriately
-
Walls Clean
-
Windows Clean & In Good Repair
-
Station Signage in Good Repair
-
Washer Dryer in Good Repair
-
Biohazard Trash Container Empty
-
Biohazard Cart – Clean / Stocked
-
MSDS Station
-
Decontamination Rooms Free of Storage not Related to Decontamination
Bunk Rooms
-
Tile Floors Clean & Waxed
-
No Wax Buildup on Floors/Basebrds
-
Carpet Clean/Vacuumed
-
Beds Made
-
Bedding Clean & in Good Repair
-
Walls Clean
-
Windows Clean & In Good Repair
-
Furniture in Good Repair
-
Fixtures Clean
-
Personal Items Stored Appropriately
-
Misc Items Stored Appropriately
-
One Television per Bunk Room
-
Ceilings in Good Repair
Day Room and Hallways
-
Tile Floors Clean & Waxed
-
No Wax Buildup on Floors/Basebrds
-
Carpet Clean/Vacuumed
-
Furniture Clean & In Good Repair
-
Walls Clean
-
Windows Clean & In Good Repair
-
Tabletops/Countertops Clean
-
Books/Manuals Neatly Arranged
-
Cabinets/Bookcases Orderly & Clean
-
Computers in Good Repair
-
Fixtures Clean
-
Misc Items Stored Appropriately
-
One Television per Day Room
-
Ceilings in Good Repair
-
Bulletin Bds Neat/Appropriate Items
-
Information Center Stocked
Kitchen
-
Tile Floors Clean and Waxed
-
No Wax Buildup on Floors/Basebrds
-
Tabletops/Countertops Clean
-
Walls Clean
-
Ceramic Tile Floors Clean
-
Waste Container Clean & Sanitary
-
Windows Clean & in Good Repair
-
Stove/Oven Clean & in Good Repair
-
Microwave Clean & in Good Repair
-
Refrigerator(s) Clean
-
Sinks Clean
-
Cabinets Orderly & Clean
-
Food Items Stored Appropriately
-
Utensils Clean/Stored Appropriately
-
Dishes Clean/Stored Appropriately
Bathroom/Locker Rooms
-
Tile Floors Clean and Waxed
-
No Wax Buildup on Floors/Basebrds
-
Tile Floors Clean
-
Countertops/Mirrors Clean
-
Walls Clean
-
Windows Clean & In Good Repair
-
Sinks Clean & in Good Repair
-
Showers Clean
-
Shower Curtains in Good Repair
-
Toilets/Toilet Stalls/Urinals Clean
-
Toilets/Urinals in Good Repair
-
Furniture in Good Repair
-
Misc. Items Stored Appropriately
-
Lockers Clean/Secured
-
Personal Items Stored Appropriately
Offices
-
Tile Floors Clean & Waxed
-
No Wax Buildup on Floors/Basebrds
-
Carpet Clean
-
Furniture Clean & In Good Repair
-
Walls Clean
-
Windows Clean & In Good Repair
-
Cabinets/Bookcases Orderly & Clean
-
Books/Manuals Neatly Arranged
-
Desk Clean and Neatly Arranged
-
Forms Stocked/Neatly Arranged
-
Files Neatly Arranged
-
Sensitive Information Secured
-
SOP Manual Up to Date
-
Computers in Good Repair
-
Bulletin Bds Neat/Appropriate Items
-
Misc. Items Stored Appropriately
-
Personal Items Stored Appropriately
-
OSHA Workplace Poster Displayed
Interior Miscellaneous
-
District Wall Maps Up to Date
-
Radio/Speaker/Claxton Operational
-
Emergency Lighting Tested
-
Means of Egress Clear
-
Exit Doors Open Easily
-
Exits are Visible and Unobstructed
-
Smoke Detectors Tested
-
Carbon Monoxide Detectors Inspected
-
Fire Extinguishers within Dates
-
Fire Extinguishers Securely Mounted
-
Fire Extinguishers Not Obstructed
-
Stove Hood System Clean
-
Hood System Serviced within 6 mths
-
No Ext Cords Repl Perm Wiring
-
No Spliced/Frayed Electrical Cords
-
No Broken or Faulty Switch/Outlets
-
Electrical Panel Not Obstructed
-
Circuit Breakers Labeled
-
No Elec Cords Thru Walls/Ceilings
-
No Missing/Broken Elec Coverplates
-
No Propane Stored In Building
-
Flam Liquids Stored in Safety
-
Containers
-
Oil Rags in Non-Comb Cont w/Lid
-
No Accumulation of Comb Materials
-
Oxygen/Comp Gas Cylinder Secured
-
No Storage in Exit Hallways
-
Cleaning Agent Containers Labeled
-
Sprinkler System Serviced
HVAC System
-
Boiler/Heat Pump in Good Repair
-
Air Conditioner in Good Repair
-
Water Heater Good Repair
Go Green Initiatives
-
Thermostat-68º Winter/72º Summer
-
Lights off Unoccupied Areas
Work Orders Needed
-
undefined
Notes
-
undefined
Sign Off
-
Signature of Inspecting Officer
