Audit

Please Note: This Information Is Reported To The Director And Manager For Corrective Action For Clinical Issues Only. All Facility Related Issues Will Be Entered Into Archibus via Safety Operations.

Fire Prevention

002. Are exit signs readily visible and illuminated?

003. Smoke barrier doors have proper gaps (1/8" max opening between doors and 1/4" from door to floor)?

004. Are smoke barrier doors self closing/automatic?

005. Are windows in smoke doors or walls made of fixed wire glass?

006. Is there a clear space of 18 in. Below sprinkler heads?

007. There are no voids in fire or smoke barriers?

008. Are fire doors free of damage and do they close properly? There are no doors propped or wedged open.

009. Are stairways free of storage?

010. Are pull stations visible?

011. Are fire extinguishers properly charged?

012. Does fire extinguisher inspection tag indicate extinguishers are being inspected monthly?

013. Are fire extinguishers accessible?

014. Are emergency evacuation route signs current?

015. Are wall mounted computers maintained in the closed position when not in use.

016. Are corridor unconstructed by equipment or furniture?

017. Are No Smoking rules followed?

018. Are stairwell doors unlocked going into the stairs from the unit?

020. Are there at least two posted emergency exits on each unit or floor?

024. Are all decoration flame retardant?

025. Are smoke detectors clean and unobstructed?

Medical Equipment

101. Is new, demo, or patient owned equipment checked by Biomed before being placed in service?

102. Staff know the proper procedure for impounding the device following a patient incident?

103. Are crash carts and defibrillators checked daily (checked by unplugging from power source)?

104. Are defibrillators pads current and do not have expired dates?

105. Are wheelchairs, IV poles, walkers, and crutches clean and in good condition?

106. Does all medical equipment and inspection tags/stickers as to when the next inspection is due?

107. Are inspections on medical equipment being completed in a timely manner?

108. Are equipment operators manuals readily available?

Utilities Management

201. Are fluorescents lights equipped with working bulbs?

202. Do emergency lights work properly in areas provided?

203. Are wall outlets child proof in areas needed?

204. All electrical panels in closets are secured and are not hampered by items being stored in closets?

205. Is electrical equipment and wiring undamaged?

206. There are no portal space heaters in the area?

207. Extension cords are not used (Exception: Emergency and/or single not ganged fused circuit breaker bars)?

208. Wall outlets are not overloaded?

209. Isle ways are not obstructed by computer/phone cables?

210. Are medical Gas Valves accessible, labeled, and clean?

217. Are all heat producing devices (toaster, coffee pots, etc.) unplugged when not in use?

218. Are restroom call lights working?

Hazardous Materials

301. Is the hazardous chemical inventory current?

302. Staff know how to retrieve SDS (MSDS)?

303. Are all chemicals properly labeled?

304. Are stored chemicals properly secured?

305. Is the soiled utility room secured and/or toxic material secured?

306. Are cleaning products/chemicals stored properly and away from clinical supplies?

307. Are waist/used chemicals disposed of properly?

308. Are chemicals stored in the proper storage cabinets according to their compatibility?

309. Are emergency eyewash stations and safety showers available in required areas?

310. Are plumbed emergency eyewash station tested weekly?

Safety Management

401. Are medication and specimen refrigerators free of food?

402. Are refrigerators clean?

403. Are refrigerator temperature logs current?

404. Are specimens and medications stored in a separate refrigerators? (In patient care areas, a separate refrigerator is used for the following: unit medications, patient food, staff food, and patient specimens.)

405. Is food consumption, including drinking, prohibited in patient care areas?

406. Is infectious waist disposed of properly?

407. Are medications and/ supplies current and do not have expiration dates?

408. Are sterile and clean supplies stored separately?

409. Are all sterile/high level disinfected items are stored at least 10" off the floor, 6" from outside walls, and 18" from ceiling fixtures?

410. Are linen cart flaps maintained in the closed position when not in use?

411. Are Sharps containers less than 3/4 full?

412. Are gas cylinders properly stored?

414. There are no damaged floor tiles, torn carpet, or trip hazards?

415. There are no damaged/missing ceiling tiles?

416. Glutaraldehyde/Cidex is not used in this area?

417. Cidex OPA Test strips are present if OPA is used and the test strip bottle is dated with discard date?

Emergency Management

501. Is there an Emergency Procedure Manual (EPM) posted?

502. Is the Emergency Procedure Manual up to date?

503. Th fire alarm location page and other emergency announcements are clearly audible in this area?

504. Does the department have a current staff recall list?

Security

601. Are valuables secured (purses, expensive equipment, etc.)?

602. Are code cart medications secure?

603. Are medication secure - (Note - none should be left in open accessible to patients or on anesthesia carts)?

604. Are fax machines in non-public areas to protect confidential information?

605. Are copy machines in non-public areas to protect confidential information?

606. Patient information is not visible from public spaces?

608. Staff is trained to question unknown individuals and report suspicious behavior?

610. Name tags available or being worn?

611. Are work stations positioned such that the public can not easily read patient identifiable information?

612. Sample drugs are secured?

Miscellaneous

999. Any additional items not noted on the inspection form?

Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.