Title Page

  • Environment of Care Rounds

  • Campus:

  • Conducted on

  • Prepared by

  • Building

  • Floor

  • Department

  • Personnel

Previous Inspections

  • Items from previous inspections have been addressed.

Safety

  • 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>

Security

  • 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

Utilities

  • 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

Dietary/Nutrition

  • 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

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