Title Page
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Environment of Care Rounds
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Campus:
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Conducted on
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Prepared by
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Building
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Floor
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Personnel
Safety
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Employees were observed using safe lifting techniques and good body mechanics.
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Ergonomic hazards identified and corrected
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Flashlights and batteries available.
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Emergency #s are readily available.
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Gurneys and wheel chairs in good repair.
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Wheeled equipment in hallway on one side.
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Supervisor confirmed eye-wash/shower stations are tested weekly and documented.
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Halls are free of uneven surfaces, cracks, loose tiles, water and other slip, trip, and fall hazards.
Security
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No personal property at Nurses station.
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Staff was observed wearing identification badges appropriately.
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Vendors were observed wearing contractor badges.
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Doors are secured.
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Locks functioning as appropriate.
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Staff personal property secured.
Electrical Safety
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Electric panels have 3 feet clearance.
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Medical shut-off panels have 3 feet clearance.
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Surge protector utilized for office equipment only.
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No plugging of one surge protector into another (piggyback).
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Electrical cords in good condition (not frayed, etc.).
Fire Safety
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Fire Alarms not blocked.
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Fire extinguishers are not blocked.
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Fire extinguisher seals are in place.
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18" storage clearance from top of ceilings.
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(3') Three feet clearance in corridors and exits clear.
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Exits are clear from obstruction.
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Exit signs lit and functioning properly.
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Fire doors latch properly and completely.
Infection Control
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Are gloves, gowns, eyewear, and masks readily available?
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Is clean linen covered?
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Is clean linen/supplies kept separate from the dirty linen/supply disposal?
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Are refrigerator logs maintained and up to date in medicine and patient refrigerators?
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Are medicines and food kept in separate refrigerator?
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Are needle boxes under 2/3 full or below full line?
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Were employees eating or drinking in designated areas only? Staff should not have food/drink in patient care areas.
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Are cleaning products the only things located under sinks? These are the only items allowed under the sinks.
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Can staff verbalize the proper cleaning/disinfecting procedures for medical equipment in their department (include high level or sterilization processes, if applicable)?
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Dated medical supplies or dedications are not expired?
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Patient use furniture in good condition - surface material intact.
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Is dirty utility room door closed/secured and labeled with appropriate signage?
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Is staff performing Hand Hygiene appropriately?
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Are isolation signs posted appropriately and precautions observed?
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Staff can verbalize PPE requirements for various isolation?
Hazardous Materials / Waste
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Staff is able to obtain SDS when requested.
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Oxygen and other gas tanks stored upright in designated holding areas and in approved containers/canisters.
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Combustibles stored in proper containers and storage kept to a minimum.
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Hazardous chemicals properly labeled and stored.
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Bio-hazardous wastes are appropriately labeled.
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All cleaning solutions are labeled.
Questionnaire / Employee Interview
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Staff able to answer: What response plan is implemented for Code Red?
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Staff able to answer: What does the acronym PASS stand for?
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Staff able to answer: What is the clearance requirement from the ceiling while storing.
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Staff able to answer: What do you do if you see suspicious person(s) or activity?
Ergonomic Questionnaire
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Does employee/staff know or demonstrate the proper technique of lifting patients?
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Is the employee/staff able to articulate some of the safe ergonomic practices?
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Does employee/staff know whom to notify in an event of an employee injury?
