Health Care Environment of Care Rounds

• Environment of Care Rounds

• Campus:

• Conducted on

  Date

• Prepared by

• Building

• Floor

• Department

• Personnel

Previous Inspections

• Items from previous inspections have been addressed.

  Yes

  No

  N/A

Safety

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

  Yes

  No

  N/A

• Staff Knowledge - Reporting Accidents/Incidents<br>

  Yes

  No

  N/A

Security

• Staff, volunteers, vendors appropriately identified

  Yes

  No

  N/A

• Staff Knowledge - Code Pink

  Yes

  No

  N/A

• Staff Knowledge - Code Gray/Silver

  Yes

  No

  N/A

• Staff Knowledge - Violence in the workplace

  Yes

  No

  N/A

Hazardous Materials / Waste

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

  Yes

  No

  N/A

• Hazardous Chemicals - properly labeled/stored

  Yes

  No

  N/A

• Infectious Waste Containers (rigid, labeled, covered)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Lead Aprons - Uniquely identified

  Yes

  No

  N/A

• Staff Knowledge - Hazardous Chemicals in their Area

  Yes

  No

  N/A

• Staff Knowledge - Accessing SDSs

  Yes

  No

  N/A

Emergency Preparedness

• Emergency numbers posted (6666 on the phones)

  Yes

  No

  N/A

• Back up/alternate communication systems

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Fire Safety

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sprinklers - 18" clearance

  Yes

  No

  N/A

• Fire Alarm/Pull Station - 3 ft. clearance

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Staff Knowledge - Oxygen Shut Off

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Medical Equipment

• Staff Knowledge - Clinical interventions for equipment failures

  Yes

  No

  N/A

Utilities

• Lights/Fixtures - covered/protected

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Electrical Panels - closed/covered, secured

  Yes

  No

  N/A

• Staff Knowledge - Utility failure procedures

  Yes

  No

  N/A

Physical Environment

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Dietary/Nutrition

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

  Yes

  No

  N/A

Infection Prevention

• Hand gel/soap dispensers functioning and contain current product

  Yes

  No

  N/A

• Under sink storage - only chemicals allowed

  Yes

  No

  N/A

• No food in Nurses' Stations

  Yes

  No

  N/A