Title Page

  • Environment of Care Rounds

  • Campus:

  • Conducted on

  • Prepared by

  • Building

  • Floor

  • Department

  • Personnel

Previous Inspections

  • Items from previous inspections have been addressed.


  • Work/Storage Areas - safe and accessible<br>(proper shelving used/secure, no above head hazards, heavier items on the bottom)

  • Staff Knowledge - Reporting Accidents/Incidents<br>


  • Staff, volunteers, vendors appropriately identified

  • Staff Knowledge - Code Pink

  • Staff Knowledge - Code Gray/Silver

  • Staff Knowledge - Violence in the workplace

Hazardous Materials / Waste

  • Oxygen/Gas Cylinders - stored upright, secured (top and bottom 3rd) or on stand/cart

  • Hazardous Chemicals - properly labeled/stored

  • Infectious Waste Containers (rigid, labeled, covered)

  • Infectious Waste Storage - Doors to storage area closed/monitored or secured

  • Waste Disposal - Appropriate disposal of waste in proper container.

  • Lead Aprons - Uniquely identified

  • Staff Knowledge - Hazardous Chemicals in their Area

  • Staff Knowledge - Accessing SDSs

Emergency Preparedness

  • Emergency numbers posted (6666 on the phones)

  • Back up/alternate communication systems

  • Staff Knowledge - Code Triage<br>(Staff's role in a disaster - stand by and respond when/where needed)

Fire Safety

  • Fire Doors - Not propped open, Unit entrance doors - positively latch

  • Fire Exits - Clear<br>Correctly marked (signs), unlocked from inside, clear of debris/equipment<br>

  • Sprinklers - 18" clearance

  • Fire Alarm/Pull Station - 3 ft. clearance

  • Electrical Cords / strip outlets<br>Not overloaded/daisy chained, In good repair, Extension cords not used

  • Fire Extinguishers<br>Clearly marked, 3 ft. clearance, On wall or in cabinet, Pressure gauges read full

  • Appliances<br>Major appliances (high wattage) in wall outlet, Clear from combustibles

  • Staff Knowledge - Oxygen Shut Off

  • Staff Knowledge - Code Red<br>RACE, PASS, Extinguisher/Fire Alarm Pull Station locations, Evacuation - horizontal/vertical

  • Were employees eating or drinking in designated areas only? Staff should not have food/drink in patient care areas.

Medical Equipment

  • Staff Knowledge - Clinical interventions for equipment failures


  • Lights/Fixtures - covered/protected

  • Med Gas Panel - 3 ft. clearance, Shut off zone identified

  • Electrical Panels - closed/covered, secured

  • Staff Knowledge - Utility failure procedures

Physical Environment

  • Work/Storage Areas - Clean, Free from hazards/clutter

  • Floors/Walkways/Walls/Ceilings - In good condition, Clean, Dry, No penetrations, Adequate lighting, Construction-no signs of dust/debris


  • Refrigerators - Clean, Employee and Patient Food separated, Patient food labeled/dated, Temperature Logs current

Infection Prevention

  • Hand gel/soap dispensers functioning and contain current product

  • Under sink storage - only chemicals allowed

  • No food in Nurses' Stations

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.