GSH Hazard rounds ( Non-clinical )

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

Exit corridors

• Are exit signs clear and in plain view in the corridor?

  Yes

  No

  N/A

• Do exit lights work properly?

  Yes

  No

  N/A

• Are exit corridors free from obstructions?

  Yes

  No

  N/A

• Are exit doors unlocked during normal business hours?

  Yes

  No

  N/A

Cleanliness/conditions.

• Are ceiling tiles broken or stained?

  Yes

  No

  N/A

• Are wall mounted items securely fastened?

  Yes

  No

  N/A

• Are floors clean?

  Yes

  No

  N/A

• Is there dust anywhere on the floor,furniture, cabinets, ETC?

  Yes

  No

  N/A

• Are trash cans emptied on a regular basis?

  Yes

  No

  N/A

• Is there trash in the corridors?

  Yes

  No

  N/A

• Are there any loose floor tiles?

  Yes

  No

  N/A

Furnishings

• Are furnishing clean?

  Yes

  No

  N/A

• Are any of the furnishing in need of repair?

  Yes

  No

  N/A

• Are there any furnishing that need to be removed from service?

  Yes

  No

  N/A

Fire safety

• Have the fire extinguishers been serviced/checked for the month?

  Yes

  No

  N/A

• Are sprinkler heads free from dust?

  Yes

  No

  N/A

• Is there 18" of clear space around sprinkler heads?

  Yes

  No

  N/A

• Are fire doors working properly?

  Yes

  No

  N/A

• Are exit doors unlocked?

  Yes

  No

  N/A

• Are any doors propped open?

  Yes

  No

  N/A

Utilities

• Are all lights working properly?

  Yes

  No

  N/A

Infection control safety

• Hand sanitizer available?

  Yes

  No

  N/A

Hazardous materials

• Sharps/Bio-waste is properly contained?

  Yes

  No

  N/A

• Are cleaning supplies properly labeled?

  Yes

  No

  N/A

• Eye wash stations working properly?

  Yes

  No

  N/A

Security management

• Are all staff wearing ID badges?

  Yes

  No

  N/A

• Do visitors have ID tags?

  Yes

  No

  N/A

• Are there valuables exposed to the public?

  Yes

  No

  N/A

Patient safety

• Is there patient information visible in the area?

  Yes

  No

  N/A

• Staff can explain what to do if they find a patient walking in the facility wearing "yellow" socks?

  Yes

  No

  N/A

Electrical safety

• Are there extension cords being used in the area?

  Yes

  No

  N/A

• Electrical outlets and plates aren't loose?

  Yes

  No

  N/A

• Items are not stored in front of electrical panels?

  Yes

  No

  N/A

• Electrical panels are locked?

  Yes

  No

  N/A

Equipment safety

• Does equipment in the area have a currant Bio-med inventory sticker?

  Yes

  No

  N/A

General concerns or questions

Sign off

• Auditor doing the rounds.

  Yes

  No

  N/A

• Add signature

  Sign