Geisinger DCM Audit

• Site conducted

  Select

Overview

• Site Code

  Campus

  Clinic Site

  Non-Clinic Site

  Other

• Archibus Building Code

• Archibus Room Code

• Date

  Date

• Prepared by

Location Information

• Region

  North Central

  North East

  South Central

  Western

  Other

• Building Name

• Location
  Address

Contact Information

• Contact Name

• Contact Email

• Contact Number

• Please take a photo of the closet before cleaning.

  Media

• What Floor is IT Room On

  Select Basement LL Ground 1 2 3 4 5 6 7 8 9 10 11 12

  • Basement
  • LL
  • Ground
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• How do you get to the room (choose all that apply)

  Select Directly off Corridor Through another Room Is located in a Sterile Area Other

  • Directly off Corridor
  • Through another Room
  • Is located in a Sterile Area
  • Other

• Specify

• Archibus Map up-to-date?

  Yes

  No

  N/A

• Archibus Sticker present?

  Yes

  No

  N/A

• Archibus Map and Sticker match?

  Yes

  No

  N/A

• Is there a placard present

  Yes

  No

• Name on IT Room Placard

• Prox Reader?

  Present and working

  Present and not working

  None

• Door Lock Type?

  Select Key Pad / Pin Hard Key No Lock Other

  • Key Pad / Pin
  • Hard Key
  • No Lock
  • Other

• Is there a key/pin on site?

  Yes

  No

  N/A

• Hard Key Label / Pin

• Dedicated Space or Shared Space?

  Dedicated

  Shared

• Equipment in a Cage?

  Yes

  No

  N/A

• Equipment in a stand-alone cabinet?

  Yes

  No

  N/A

• Ceiling

  No Ceiling / Open

  Suspended / Drop Ceiling

  Hard Ceiling

• Flooring

  Tile

  Plain Concrete / no Tiles

  Carpeted

  Raised

  Other

• Are any Windows present

  Yes

  No

• Rack bolted down securely?

  Yes

  No

• Camera Installed?

  Yes

  No

  N/A

• Fire Suppression?

  Select wet / pre-action is present dry / chemical is present None / unknown

  • wet / pre-action is present
  • dry / chemical is present
  • None / unknown

• Leak Detection?

  Yes

  No

• Cooling System

  Select Split System is present and working Split System is present and not working House Air cools the Room No cooling present

  • Split System is present and working
  • Split System is present and not working
  • House Air cools the Room
  • No cooling present

• Temperature

  Select Above 75 degrees Below 75 degrees No thermostat is present

  • Above 75 degrees
  • Below 75 degrees
  • No thermostat is present

• Available Power

  Select Normal Emergency Unknown Other

  • Normal
  • Emergency
  • Unknown
  • Other

• Network Equipment plugged into Emergency or UPS Power

  Yes

  No

  Unknown

  Other

• Is there a UPS device present?

  Yes

  No
UPS Devices

• Select Installed Device

  Select Liebert GXT4 GXT4 with extended Battery Pack Liebert GXT3 GXT3 with extended Battery Pack Liebert GXT2 APC Model HP Model Tripp-Lite Model Other

  • Liebert GXT4
  • GXT4 with extended Battery Pack
  • Liebert GXT3
  • GXT3 with extended Battery Pack
  • Liebert GXT2
  • APC Model
  • HP Model
  • Tripp-Lite Model
  • Other

• Connection Type in UPS?

  Ethernet

  USB/Serial

  Other

  None

• Connection being used?

  Yes

  No

• Is there a PDU present?

  Yes

  No

  N/A
Power Switching Device

• Select Installed PDU

  Select MicroPod APC PDU Strips Unknown Nothing Other

  • MicroPod
  • APC
  • PDU Strips
  • Unknown
  • Nothing
  • Other

• Switched to what power load type?

  Utility/Maintenance

  UPS

  Auto switching

  Unknown

  Other

• ISS/RTI to remove items from this closet

  Yes

  No

• Non-IT Room Contents

  Select Chemicals Medical Gases General Storage Other

  • Chemicals
  • Medical Gases
  • General Storage
  • Other

• Specify

• Issues / Comments

• Please take a photo of the closet after cleaning.

  Media

• Completed by (Full Name and Signature)

  Sign