Healthcare - Safety and Fire Assessment and Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• OIC: NCOIC:

Program Assessment

• Can personnel describe or demonstrate safety risk in the environment of care?<br>

  Yes

  No

  N/A

• Can personnel describe or demonstrate actions to eliminate, minimize, or report safety risks in the environment?

  Yes

  No

  N/A

• Are aLl areas in which patients or staff may walk must be kept free from slipping and tripping? Are corridors leading to or from exits, and emergency exits touted, as well as work areas are kept free and unobstructed from slipping or tripping hazards? ( I.e. no beds, wheelchairs, or carts stored in hallways and snow and ice removed)

  Yes

  No

  N/A

• Do all newcomers receive fire, safety, HAZCOM, training and job specific standards before starting to work and it's documented?

  Yes

  No

  N/A

• Are all Safety, EC policies and procedures up to date? Are they readily available to all personnel?

  Yes

  No

  N/A

• Can personnel describe or demonstrate their specific role(s) and responsibilities in preparing for building evacuation?

  Yes

  No

  N/A

• Can personnel describe or demonstrate location and proper use of equipment for evacuating or transporting patients to refuge?

  Yes

  No

  N/A

• Are annual fire drills documented in the individuals 6-sided folders? Post a copy of the fire drill evaluation in fire log book.

  Yes

  No

  N/A

• Are employees part of a continuing training program?

  Yes

  No

  N/A

• Are self inspections conducted monthly and documented? Are corrective actions initiated, work orders submitted where applicable, and a log kept?

  Yes

  No

  N/A

• Are defibrillators checked daily and documented?

  Yes

  No

  N/A

• Are pre-holiday or pre-season safety briefings conducted and documented?

  Yes

  No

  N/A

• Is there a monitoring procedure in place to ensure progress is being made in correcting deficiencies that are discovered during fire & safety inspections? (Safety and Fire)

  Yes

  No

  N/A

• Are accidents recorded by the section safety representatives and the appropriate report is prepared and forwarded to the Health Center Safety Manager in a timely manner?

  Yes

  No

  N/A

• Do NCOIC/Supervisor investigate accidents and take prompt and adequate corrective actions to prevent occurrence?

  Yes

  No

  N/A

• Do NCOIC/Supervisors ensure appropriate accident report forms completed and sent to the Health Center safety office?

  Yes

  No

  N/A

Emergency Eyewash Stations and Showers

• Are adequate eye wash stations where needed (i.e. X-ray and Lab)?

  Yes

  No

  N/A

• Are emergency eyewash stations and showers tested weekly and documented? (Let water run 5 minutes). Room number for eyewash stations: We're they all checked by safety?

  Yes

  No

  N/A

• Are emergency eyewash stations clean with eye cap protectors installed?

  Yes

  No

  N/A

• Are eyewash stations and/or showers unobstructed with items? (i.e. boxes, equipment, etc.)

  Yes

  No

  N/A

Oxygen Tanks and Compressed Gases

• Are "No Smoking" and "No Smoking Oxygen Tanks In Use" signs posted where needed?

  Yes

  No

  N/A

• Are Oxygen cylinders are stored separately from flammable and combustible material, are secured in an approved fire resistant room, or flammable cabinet? Storage room doors latch shut when closed? (Maximum one cylinder use and reserve per patient room) (Safety and Fire)

  Yes

  No

  N/A

• Are oxygen tanks stored separately from flammable gases?

  Yes

  No

  N/A

• Are "Do Not Oil" signs posted on oxygen tanks?<br>

  Yes

  No

  N/A

• Are compressed gas cylinders properly labeled and secured to prevent falling? Are the caps on when regulator is not in place?

  Yes

  No

  N/A

Radiology

• Do all switches and operating devices outside X-ray rooms operable?

  Yes

  No

  N/A

• Are lead aprons inspected and documented?

  Yes

  No

  N/A

• Are radiation and pregnancy warning triangle posted in X-ray rooms?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Is suitable PPE available and worn?

  Yes

  No

  N/A

• Is PPE available, properly maintained and used as required (gloves, goggles, aprons, mask)?

  Yes

  No

  N/A

Sterilizers

• Is the steam always shut off before opening any sterilizer?

  Yes

  No

  N/A

Additional Safety Related Topics

• Is the temperature of hot water for the hot water bags and baths tested with a thermometer?

  Yes

  No

  N/A

• Are there other structural safety hazards existing?

  Yes

  No

  N/A

• Are there tripping hazards existing?

  Yes

  No

  N/A

• Are hazards identified and corrective actions taken and documented?

  Yes

  No

  N/A

• Are delinquent safety, fire, or HAZCOM work orders prioritized and followed up?

  Yes

  No

  N/A

• Are drug cabinets and distinctive bottles labeled?

  Yes

  No

  N/A

• Are poisons stored in locked containers with antidote information?

  Yes

  No

  N/A

• Are safety related supply items requisitioned when needed?

  Yes

  No

  N/A

• Are emergency phone numbers and the bomb threat checklists displayed by all phones?

  Yes

  No

  N/A

• Are storage rooms organized with heavier items on lower shelves?

  Yes

  No

  N/A

• Are rooms used for storage are fire protected? Do doors latch shut when closed? (Fire)

  Yes

  No

  N/A

• Are Items stored with 18 inches of clearance between sprinklers and stored materials? (a plane of 18" across the room) (Fire)

  Yes

  No

  N/A

• Are curtains changed out every six months? (Health)

  Yes

  No

  N/A

• Are personnel aware that emergency numbers are on their Emergency INFO Card?

  Yes

  No

  N/A

• Are private carpets forbidden in healthcare facilities unless they are of a Class A (flame resistant) fire rating? (Fire)

  Yes

  No

  N/A

Flammable and Combustible Liquids

• Are liquid chemicals stored below eye level in all sections?

  Yes

  No

  N/A

• Are Rooms used for storage of flammable liquids or combustible materials are either protected with a sprinkler system or with one-hours fire-resistive construction? Doors close automatically and latch shut.

  Yes

  No

  N/A

• Are acids, flammables, and explosive liquids stored in approved safety cabinets?

  Yes

  No

  N/A

Electrical Safety

• Are electrical outlets in good condition?

  Yes

  No

  N/A

• Are authorized surge protectors only used?

  Yes

  No

  N/A

• Are fuse boxes appropriately labeled where applicable?

  Yes

  No

  N/A

• Are electrical extension cords or devices must be safety/surge protected? <br>Electrical space heaters are not allowed (no exceptions). (Safety and Fire)

  Yes

  No

  N/A

• If approved transformers used are they place on an approved surface? (Not to be placed on metal surfaces)

  Yes

  No

  N/A

• Are equipment and tools in safe condition, and power cords are not worn, frayed, or abraded?

  Yes

  No

  N/A

Hazardous Materials

• Are personnel HAZCOM trained?

  Yes

  No

  N/A

• Are Material Safety Data Sheets (MSDS) for hazardous chemicals readily available?

  Yes

  No

  N/A

• Is personal protective equipment available and used when handling hazardous materials?

  Yes

  No

  N/A

• Is there a log of MSDS maintained IAW hazard communication standards and posted as applicable?

  Yes

  No

  N/A

• Are hazardous material containers properly labeled?

  Yes

  No

  N/A

• Are all applicable hazardous materials in secondary containers?

  Yes

  No

  N/A

• Are spill-response kits available and placed in appropriate sections, filled when needed?

  Yes

  No

  N/A

• Are hazardous materials and cleaning agents stored properly? (i.e. away from patients, children, and visitors)

  Yes

  No

  N/A

SHARP Containers

• Are SHARP containers affixed to the wall and emptied when 3/4 full?

  Yes

  No

  N/A

Laboratory

• Are laboratory rooms locked at all times when not in use?

  Yes

  No

  N/A

Fire Prevention

• Are utility and fire alarm systems freely accessible, and monthly fire extinguisher inspections conducted and recorded on inspection tag. ( e.g. Gauge is in the Green, pull-pin seal not broken, no obvious damage & hung on wall)

  Yes

  No

  N/A

• Are stairwells kept clear of trash, supplies, furniture, and bicycles? Nothing is to be stored in the stairwells. Ensure floor mats are not used to prop open the exit doors. (Fire)

  Yes

  No

  N/A

• Are all exits well maintained and exit doors function properly? Must latch shut! (Fire)<br>Check all individual room doors to ensure they also latch.

  Yes

  No

  N/A

• Are emergency exit signs functioning properly and not blocked from view? If light is not lit, call in a work request (Maintenance Contractor Tests the batteries) (Fire).

  Yes

  No

  N/A

• Are all pathways to and from each exit well illuminated? (Safety and Fire)

  Yes

  No

  N/A

• Are keys for unlocking patient bathrooms and toilets readily available in case of an emergency?

  Yes

  No

  N/A

• Are there any broken or water damaged ceiling tiles? Water damaged ceiling tiles harbor bacteria. If "YES", call in a work order to have them replaced. (486-8417) (Health)

  Yes

  No

  N/A

Medical Equipment

• Can medical equipment users describe or demonstrate capabilities, limitations, and special applications of equipment?

  Yes

  No

  N/A

• Can users of medical equipment describe or demonstrate operating and safety procedures for equipment use?

  Yes

  No

  N/A

• Can users of medical equipment describe or demonstrate emergency procedures in event of equipment failure?

  Yes

  No

  N/A

• Can users of medical equipment describe or demonstrate procedures or reporting equipment management problems, failures, and user errors?

  Yes

  No

  N/A

• Can personnel describe the purpose of the DD Form 2163 (Calibration of Medical Equipment)?

  Yes

  No

  N/A

• Do personnel routinely check the DD Form 2163 for expiration dates?

  Yes

  No

  N/A

• Are user's manuals for equipment readily available and complete?

  Yes

  No

  N/A

• Are nurse call alarms tested monthly, to include bathrooms? Must be able to see the visual alarm and hear the audible alarm. Additionally, if you have security alarms on any doors, they too must be tested monthly. (Fire and Safety)<br>Location(s) of Nurse Call Device(s): <br>Primary Location(s) where alarm sounds:

  Yes

  No

  N/A

• Are grab bars/hand rails and nurse call buttons provided in patient bathrooms and toilets?

  Yes

  No

  N/A

Utility Systems

• Can utility system users describe or demonstrate utility system capabilities, limitations, and special applications?

  Yes

  No

  N/A

• Can utility system users describe or demonstrate emergency procedures in the event of a system failure?

  Yes

  No

  N/A

• Can utility system users describe or demonstrate emergency procedures for reporting utility systems management problems, failures, and user errors?

  Yes

  No

  N/A

• Can utility system users describe the location and use of emergency shut-off controls?

  Yes

  No

  N/A

• Can utility users describe who to contact in the event of an emergency?

  Yes

  No

  N/A

• Mr. Jason Shannon - USAHC-V Safety and Occupational Health Manager

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