Georgia Regional Hospital Atlanta Environmental Surveillance Round.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

Grounds and Building Exterior Safety.

• Parking areas are in good repair and free of hazardous cracks, tripping hazards and obstructions, ect.

  Yes

  No

  N/A

• Walkways are in good repair; and fall hazards are marked and protected.

  Yes

  No

  N/A

• Traffic and directional signs/markings are appropriate, adequate, unobstructed and in good repair.

  Yes

  No

  N/A

• Exterior lighting is present, illuminated, and adequate for the area.

  Yes

  No

  N/A

• A No Firearms Allowed poster is displayed and legible.

  Yes

  No

  N/A

• Fenced recreation areas are enclosed and free of debris and sharp objects.

  Yes

  No

  N/A

• Outdoor furnishings are in good repair.

  Yes

  No

  N/A

• Front entrance is neat and free of trash.

  Yes

  No

  N/A

Electrical Safety - Interior

• Electrical cords are protected from damage and do not present a trip hazzard.

  Yes

  No

  N/A

• Extension cords are not used as permanent wiring.

  Yes

  No

  N/A

• Are is free of unauthorized plug adapters.

  Yes

  No

  N/A

• No power strips are on the floor.

  Yes

  No

  N/A

• Outlets are free of cracks or loose face plates.

  Yes

  No

  N/A

• Areas free of other hazardous electrical conditions such as exposed wiring.

  Yes

  No

  N/A

• Electrical panel are free of obstruction.

  Yes

  No

  N/A

• Electrical panel doors are closed and locked.

  Yes

  No

  N/A

• Breakers/switches are properly labeled.

  Yes

  No

  N/A

• Generators are inspected regularly and are in good repair.

  Yes

  No

  N/A

• Bio-Med equipment has documentation of current inspection, testing/preventive maintenance.

  Yes

  No

  N/A

• Bio-Med equipment inventory is current within six months.

  Yes

  No

  N/A

Fire Safety.

• All fire/smoke partition doors are properly marked and free of paint.

  Yes

  No

  N/A

• All fire/smoke partition doors operate properly.

  Yes

  No

  N/A

• Exit access doors are accessible at all times.

  Yes

  No

  N/A

• Fire extinguishers are in designated cabinets/locations within 75 feet in any directions.

  Yes

  No

  N/A

• Fire extinguishers are stored with 3 feet of clearance in any directions.

  Yes

  No

  N/A

• K-type fire extinguisher is located within 30 feet of any grease producing equipment.

  Yes

  No

  N/A

• Monthly inspections of portable fire extinguishers are documented on the inspection tag, are inspections are current.

  Yes

  No

  N/A

• Annual inspection of portable fire extinguishers is documented on the inspection tag, and inspection is current.

  Yes

  No

  N/A

• Gauge on all portable fire extinguishers indicates proper charge.

  Yes

  No

  N/A

• Portable fire extinguishers are in good condition (connections tight, no deterioration on hose, pin in place, seal intact, etc.).

  Yes

  No

  N/A

• Emergency lights are operational.

  Yes

  No

  N/A

• Exit access corridors are free of obstructions.

  Yes

  No

  N/A

• Flammable/combustible liquids are properly stored.

  Yes

  No

  N/A

• Areas where oxygen is used/stored are clearly marked.

  Yes

  No

  N/A

• Exit doors open in the direction of exit egress.

  Yes

  No

  N/A

• Exit signs are appropriately placed, illuminated, and indicate the proper direction

  Yes

  No

  N/A

• Exit signs, sprinkler heads, and pull stations are free from obstructions (e.g. plants, decorations, etc.)

  Yes

  No

  N/A

• There is 18 inches of clearance between storage and sprinkler heads.

  Yes

  No

  N/A

• Fire alarm pull stations have three feet of clearance in all directions.

  Yes

  No

  N/A

• Rooms and offices are free of excessive fire loading

  Yes

  No

  N/A

• Rooms and offices are free of loosely attached combustible materials that do not exceed 20% of each wall area or are located within four feet of room exit.

  Yes

  No

  N/A

• All buildings are free of portable heating devices.

  Yes

  No

  N/A

• Compressed gas cylinders are properly secured with protective caps in place when not in use.

  Yes

  No

  N/A

• Full and empty oxygen cylinders in storage are segregated and labeled.

  Yes

  No

  N/A

• Where compressed gas storage exceeds 300 cu. ft., there is a designated, protected storage room.

  Yes

  No

  N/A

• Less than 12 E-tanks (300 cu. Ft., oxygen) are stored in the smoke compartment.

  Yes

  No

  N/A

General Safety.

• Stickers are present on telephones showing the telephone #'s of police, fire, ambulance, internal page, Ga. Poison Control, and Safety Data Sheets (SDS) information.

  Yes

  No

  N/A

• Bomb threat instructions are on or near telephones.

  Yes

  No

  N/A

• There are no conditions that would put the individual at risk for trips or falls.

  Yes

  No

  N/A

• Wet floor signs are used appropriately when the floor is wet.

  Yes

  No

  N/A

• All chemicals, including secondary containers, are properly labeled and labels are legible. Secondary containers are labeled in accordance with applicable regulations

  Yes

  No

  N/A

• A non-skid material/mat is present in showers and bathtubs where appropriate.

  Yes

  No

  N/A

• Food is within the expiration/recommended use date.

  Yes

  No

  N/A

• The nurse call system is operational and there is an alternative signaling mechanism such as a bell in the event of failure

  Yes

  No

  N/A

• A corner mirror or bubble window is present and in good repair in all seclusion/time out rooms.

  Yes

  No

  N/A

• Furnishings in all seclusion/time-out rooms are bolted to the floor.

  Yes

  No

  N/A

• All treatment areas are free of suicide risks.

  Yes

  No

  N/A

• Seclusion rooms are free of other visible hazards (sharp edges, suicide risks, etc.).

  Yes

  No

  N/A

• Employee lockers are free of hazardous materials and excessive quantities of combustible materials.

  Yes

  No

  N/A

• Storage rooms are clean and safe.

  Yes

  No

  N/A

• No objects are stored within 18 inches of the ceiling.

  Yes

  No

  N/A

• No holes or penetrations in ceilings, walls, or floors.

  Yes

  No

  N/A

• No doors are propped open.

  Yes

  No

  N/A

• Faucets and pipes are in good repair (e.g., no drips).

  Yes

  No

  N/A

• Washers/dryers are clean and in good repair.

  Yes

  No

  N/A

• Clean linen is kept covered and separate from soiled linen.

  Yes

  No

  N/A

• Refrigerators are labeled to identify staff, individual, or medication use.

  Yes

  No

  N/A

• Temperature logs for refrigerators are readily available and current.

  Yes

  No

  N/A

Hazardous Chemicals/Materials

• An inventory of chemicals is available.

  Yes

  No

  N/A

• There is a separate storage area for chemicals.

  Yes

  No

  N/A

• Chemicals are stored properly on the shelves. Incompatible chemicals are not stored together.

  Yes

  No

  N/A

• The chemical storage area is free of debris and clutter, which would hamper cleaning of spills or quick exit in an emergency.

  Yes

  No

  N/A

• The "right to know" poster is posted on the official bulletin board.

  Yes

  No

  N/A

• Appropriate and adequate personal protective equipment (PPE) is accessible to all employees.

  Yes

  No

  N/A

• Bloodborne pathogen precaution procedures are in place.

  Yes

  No

  N/A

• Sharps containers are no more than 2/3 full or as indicated on the container.

  Yes

  No

  N/A

• All red bag biomedical wastes are properly handled and stored.

  Yes

  No

  N/A

Security.

• There is controlled access to security sensitive areas and confidential information such as medical records.

  Yes

  No

  N/A

• Medication carts are locked when unattended.

  Yes

  No

  N/A

• Medication rooms are locked when unattended.

  Yes

  No

  N/A

• Doors required to be locked can be locked or unlocked easily

  Yes

  No

  N/A

• Security fences are in good repair.

  Yes

  No

  N/A

Employee ID Badges and Employee Knowledge

• Staff wears a legible and visible ID badge on the chest of the outer garment.

  Yes

  No

  N/A

• Staff has keys for locked fire alarm pull station. Staff has keys for all locked exits.<br>

  Yes

  No

  N/A

• Staff knows the procedures in the event of a tornado watch or warning.

  Yes

  No

  N/A

• Staff can describe the process for Code Red (RACE) and how to use a fire extinguisher (PASS).

  Yes

  No

  N/A

• Staff can describe their role in the Emergency Operations Plan.

  Yes

  No

  N/A

• Emergency Operations Plan is current.

  Yes

  No

  N/A

• Staff can describe how to properly dispose of bio-medical waste.

  Yes

  No

  N/A

• Staff knows how to report abuse of individuals served in DBHDD hospitals. Staff knows how to report an accident/injury. Staff knows how to or to whom to report a safety hazard.<br>

  Yes

  No

  N/A

Environmental Evaluation – Cleanliness of Individual’s Room

• Doors are in good repair.

  Yes

  No

  N/A

• Baseboards/corners are free of wax and/or soil buildup.

  Yes

  No

  N/A

• Floors are free of dirt/spills. Floors are free of urine/feces. Floors are free of rust, stains and scuff marks.<br>

  Yes

  No

  N/A

• Walls are free of washable stains and spills.

  Yes

  No

  N/A

• Light fixtures are clean.

  Yes

  No

  N/A

• Ceiling lights are illuminated when light switch is turned on.

  Yes

  No

  N/A

• Vent grilles are clean.

  Yes

  No

  N/A

• Interior windows, window sills, and screens are clean.

  Yes

  No

  N/A

• Rooms are free of evidence of insects/rodents.

  Yes

  No

  N/A

• Ceiling is in good repair and free from evidence of dirt, mold, dust, and stains.

  Yes

  No

  N/A

Maintenance and Cleanliness of Restroom and Shower

• Restrooms and Showers are free of odors.

  Yes

  No

  N/A

• Walls are in good repair.

  Yes

  No

  N/A

• Entrance doors are in good repair. Room is numbered and appropriately used.<br>

  Yes

  No

  N/A

• Restrooms and showers are accessible to individuals

  Yes

  No

  N/A

• Area is ventilated sufficiently.

  Yes

  No

  N/A

• Toilets are in good repair. Toilet partitions/doors/grab bars are in good repair.<br>

  Yes

  No

  N/A

• Soap dispensers are in good repair. Mirrors are in good repair.<br>

  Yes

  No

  N/A

Hallways, Lobby Areas, and Day Areas

• Floors are free of dirt and spells. Floors are free of urine/feces. Floors are free of rust, stains and scuff marks.<br>

  Yes

  No

  N/A

• Vent grilles are clean. Light fixtures are clean.<br>

  Yes

  No

  N/A

• Light fixtures are clean.

  Yes

  No

  N/A

• Drinking fountains are clean.

  Yes

  No

  N/A

• Antibacterial gel dispensers are in good repair.

  Yes

  No

  N/A

• Water fountains are in good repair.

  Yes

  No

  N/A

• Walls are in good repair.

  Yes

  No

  N/A

• Doors are in good repair.

  Yes

  No

  N/A