Hillcrest Annual Facility Inspection

• Whole Facility Annual Audit

• Document No

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Yes

  No

  N/A

• 1.2 - Are there no outstanding actions?

  Yes

  No

  N/A

2.0 - Fire Prevention

• 2.1 - Door wedged or propped open, none found?

  Yes

  No

  N/A

• 2.2 - Fire doors are not blocked by carts, equipment, or materials?

  Yes

  No

  N/A

• 2.3 - Extinguishers is not missing damaged, or discharged?

  Yes

  No

  N/A

• 2.4 - Extinguishers has current inspection documentation?

  Yes

  No

  N/A

• 2.5 - Extinguishers clear of obstructions?

  Yes

  No

  N/A

• 2.6 - Sprinkler Heads/Smoke Detectors are clean & intact?

  Yes

  No

  N/A

• 2.7 - Indicator Lights are not obstructed?

  Yes

  No

  N/A

• 2.8 - Fire Exit signs are illuminating and working properly?

  Yes

  No

  N/A

• 2.9 - Fire Doors close and latch properly?

  Yes

  No

  N/A

• 2.10 - Emergency response flip charts are located at all phones and staff are aware of them.

  Yes

  No

  N/A

• 2.11 - Doors to Soiled/Clean/Hazardous Materials Rooms closed locked?

  Yes

  No

  N/A

• 2.12 - Emergency Exit Corridors / Doors are clear?

  Yes

  No

  N/A

• 2.13 - Warden kit is located in a prominent position with all required items present?

  Yes

  No

  N/A

• 2.14 - Flammables, stored appropriately?

  Yes

  No

  N/A

3.0 - Electrical Safety

• 3.1 - Electrical outlets are not damaged or loose?

  Yes

  No

  N/A

• 3.2 - Critical equipment is plugged into Red Outlet?

  Yes

  No

  N/A

• 3.3 - All extension cords are equipped with a ground prong?

  Yes

  No

  N/A

• 3.4 - All switches, receptacles and computer boxes have covers or plates?

  Yes

  No

  N/A

• 3.5 - No double adapters in use?

  Yes

  No

  N/A

• 3.6 - If power boards are in use, is there only one per powerpoint and is it individually switched?

  Yes

  No

  N/A

• 3.7 - Portable equipment is tested and tagged and in date?

  Yes

  No

  N/A

4.0 - General Safety

• 4.1 - Handrails are attached firmly to the walls?

  Yes

  No

  N/A

• 4.2 - All wheelchairs are in good repair and with both footrest?

  Yes

  No

  N/A

• 4.3 - Non slip surfaces for all wet areas?

  Yes

  No

  N/A

• 4.4 - Floors - tiles, carpet in good repair - no trip hazards?

  Yes

  No

  N/A

• 4.5 - All lights working?

  Yes

  No

  N/A

• 4.6 - Storage Rooms clean and orderly?

  Yes

  No

  N/A

• 4.7 - No items are being stored under the sinks?

  Yes

  No

  N/A

• 4.8 - Step ladders available to reach high places are in good shape?

  Yes

  No

  N/A

• 4.9 - No electrical cords, telephone and computer wires in area that might entangle feet?

  Yes

  No

  N/A

• 4.10 - Desk, chairs, furniture in safe condition?

  Yes

  No

  N/A

• 4.11 - Patient Room furniture in safe condition?

  Yes

  No

  N/A

• 4.12 - No evidence of food, drinks or eating occurring around computers or nurse station?

  Yes

  No

  N/A

• 4.13 - Bins located at suitable points and emptied regularly?

  Yes

  No

  N/A

5.0 - Hazardous Marerial

• 5.1 - Eye wash station inspected weekly and documented?

  Yes

  No

  N/A

• 5.2 - PPE and spill kits located with all bulk hazardous storage?

  Yes

  No

  N/A

• 5.3 - Medical gas cylinders are stored where full and empties are separated?

  Yes

  No

  N/A

• 5.4 - Medical gas cylinders are restrained properly in bins, racks, or hand carts?

  Yes

  No

  N/A

• 5.5 - Biohazard containers are stored properly?

  Yes

  No

  N/A

• 5.6 - Sharps boxes are no more than 3/4 full; syringe disposed of properly?

  Yes

  No

  N/A

• 5.7 - Staff are able to obtain a SDS? Staff are aware of options?

  Yes

  No

  N/A

• 5.8 - Secondary container are labeled properly?

  Yes

  No

  N/A

• 5.9 - Hazardous materials properly stored?

  Yes

  No

  N/A

6.0 - Security Management

• 6.1 - Employee personal items are secured out of sight?

  Yes

  No

  N/A

• 6.2 - Employee I.D. Badges visible and worn properly?

  Yes

  No

  N/A

• 6.3 - Confidential Materal secured /protected?

  Yes

  No

  N/A

• 6.4 - High risk patient's, equipment areas, hazardous material area rooms are secure?

  Yes

  No

  N/A

• 6.5 - Medications secured?

  Yes

  No

  N/A

• 6.6 - Doors with security hardware operate properly?

  Yes

  No

  N/A

• 6.7 - Code carts locked and in view of staff?

  Yes

  No

  N/A

7.0 - Utilities Management

• 7.1 - All lights are operational, no lights out?

  Yes

  No

  N/A

• 7.2 - Ceiling tiles, none discolored,/wet/damaged?

  Yes

  No

  N/A

• 7.3 - HVAC System - Air temperature within comfortable range?

  Yes

  No

  N/A

• 7.4 - Plumbing, faucets,, toilets operational (no leaks)?

  Yes

  No

  N/A

• 7.5 - Ice machine clean and maintenance on schedule?

  Yes

  No

  N/A

• 7.6 - Loading areas clear and uncluttered?

  Yes

  No

  N/A

8.0 - External grounds

• 8.0 - Walkways and grounds are in good condition with no trip hazards?

  Yes

  No

  N/A

Comments

• Additional Comments

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