Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Rated Doors
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Fire Rated doors close and latch? Cross Corridor doors, Soiled Utility doors,
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Fire Rated doors close and latch? Cross Corridor doors, Soiled Utility doors,
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Smoke Rated doors close and latch? Doors that open into a main corridor ex: Patient room doors, Office doors, Closet doors
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Smoke Rated doors close and latch? Doors that open into a main corridor ex: Patient room doors, Office doors, Closet doors
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Smoke Rated doors close and latch? Doors that open into a main corridor ex: Patient room doors, Office doors, Closet doors
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Doors free of door wedges?
Physical Environment
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Corridors and EXIT doors unobstructed? only Crash Carts and In-Use Isolation Carts can be in corridors full time. All other items are considered storage and not allowed
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Exit signs illuminated?
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Exit signs illuminated?
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Stairwells clear? No Dust or dirt?
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Ceiling tiles not stained, not cracked, no holes. This protects the Ceilings 1hour Smoke Barrier
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Ceiling tiles not stained, not cracked, no holes. This protects the Ceilings 1hour Smoke Barrier
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Ceiling tiles not stained, not cracked, no holes. This protects the Ceilings 1hour Smoke Barrier
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Ceiling tiles not stained, not cracked, no holes. This protects the Ceilings 1hour Smoke Barrier
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Ceiling tiles not stained, not cracked, no holes. This protects the Ceilings 1hour Smoke Barrier
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Lighting - area properly lit for proper use in work area, free of dust & debris, in good working order?
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Lighting - area properly lit for proper use in work area, free of dust & debris, in good working order?
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Fire alarms accessible?
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Fire extinguishers accessible?
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Fire extinguishers accessible?
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Smoke detectors unobstructed?
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Sprinklers unobstructed, free of dust, trim rings or covers in place?
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Crash Carts - Defibrillator is plugged into the wall with 2 green lights on? o2 cylinder is properly supported, supports are tight and secure?
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Crash Carts - Defibrillator is plugged into the wall with 2 green lights on? o2 cylinder is properly supported, supports are tight and secure?
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Medical gas stored appropriately? Cylinders stored in portable carts, chained to wall or securely placed in storage rack.
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Medical gas stored appropriately? Cylinders stored in portable carts, chained to wall or securely placed in storage rack.
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Medical gas stored appropriately? Cylinders stored in portable carts, chained to wall or securely placed in storage rack.
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Medical gas stored appropriately? Cylinders stored in portable carts, chained to wall or securely placed in storage rack.
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Patient Rooms - wall mounted items securely deported to walls, cabinets in good condition, head wall bed locators in place, all lighting working, faucets working properly no leaks and in good condition, bathroom no leaks at toilet or shower/tub, TV working properly, TV cable and cord neat and supported, PATIENT ROOM IS SAFE?
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Patient Rooms - wall mounted items securely deported to walls, cabinets in good condition, head wall bed locators in place, all lighting working, faucets working properly no leaks and in good condition, bathroom no leaks at toilet or shower/tub, TV working properly, TV cable and cord neat and supported, PATIENT ROOM IS SAFE?
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Patient Rooms - wall mounted items securely deported to walls, cabinets in good condition, head wall bed locators in place, all lighting working, faucets working properly no leaks and in good condition, bathroom no leaks at toilet or shower/tub, TV working properly, TV cable and cord neat and supported, PATIENT ROOM IS SAFE?
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Patient Rooms - wall mounted items securely deported to walls, cabinets in good condition, head wall bed locators in place, all lighting working, faucets working properly no leaks and in good condition, bathroom no leaks at toilet or shower/tub, TV working properly, TV cable and cord neat and supported, PATIENT ROOM IS SAFE?
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Patient Rooms - wall mounted items securely deported to walls, cabinets in good condition, head wall bed locators in place, all lighting working, faucets working properly no leaks and in good condition, bathroom no leaks at toilet or shower/tub, TV working properly, TV cable and cord neat and supported, PATIENT ROOM IS SAFE?
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Isolation Rooms working properly - ping pong ball in the proper position with the room door closed.
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Isolation Rooms working properly - ping pong ball in the proper position with the room door closed.
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Nurse Station / Break Room / Nurse Mgr office in good condition and working order?<br><br>
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Nurse Station / Break Room / Nurse Mgr office in good condition and working order?<br><br>
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Nurse Station / Break Room / Nurse Mgr office in good condition and working order?<br><br>
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Nurse Station / Break Room / Nurse Mgr office in good condition and working order?<br><br>
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Nurse Station / Break Room / Nurse Mgr office in good condition and working order?<br><br>
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Wall Mounted items secure and in good shape? This includes handrails, pictures, wall mounted lights, sharps containers, mirrors, blood pressure baskets, paper towel holders, gel dispensers, file holders, signs, shelving.
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Clean & Soiled Utility room door self close and latches.
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Clean & Soiled Utility room door self close and latches.
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Linen covered? Clean linen carts must be covered at all times.
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Linen covered? Clean linen carts must be covered at all times.
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Storage Room - free of clutter, no corrugated boxes on floor, no items within 18" of ceiling, no hazardous materials stored ?
MEP
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Electrical Power-strips mounted securely to the wall or cabinet.
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Electrical Power-strips mounted securely to the wall or cabinet.
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Electrical panels Surfaced Mounted in Corridors LOCKED?
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Electrical panels Surfaced Mounted in Corridors LOCKED?
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Electrical Room Doors closed and Locked, lights work, free from storage, no noise or unusual smells, free of dust?
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Electrical Room Doors closed and Locked, lights work, free from storage, no noise or unusual smells, free of dust?
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Mechanical Room Doors closed and Locked, lights work, free from storage, no noise or unusual smells, free of dust?
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Mechanical Room Doors closed and Locked, lights work, free from storage, no noise or unusual smells, free of dust?
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Tele-Comm Room Doors closed and Locked, lights work, free from storage, no noise or unusual smells, free of dust?
Comments
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