Title Page

  • Conducted on

  • Prepared by

  • Location

Technology

Devices (computers, printers, iPads, etc)

  • Are devices in good working order?

  • If any device is less than in GOOD working order, record details.

  • Are devices free of visual damage?

  • If any device has any damage, record details.

  • Are passwords stored on devices in a manner that allows others to use access to secured passwords (on sticky notes, etc.)

  • If yes, record details.

  • Do devices match Asset Guard information?

  • If no, record details.

  • Has all information been updated in Asset Guard for this date’s inspection?

  • If no, record details.

  • Are devices stored in a secure location when not in use?

  • Record details. Include storage location and if location is locked?

  • Do all devices have chargers?

  • If no, record details.

  • Do all devices hold a charge adequately?

  • If no, record details.

  • Are there any other needs for devices that should be followed up?

  • If yes, what needs are being addressed?

  • Do any employees leave the facility at any time with devices?

  • If yes, does this employee have written approval to remove device from facility? (Attach documentation)

Physical Assesment

  • Are all rehabilitation department areas secure when not in use?

  • How are areas secured?

  • Is there printed or written PHI in the department areas?

  • If yes, describe what manner of PHI?

  • Is printed or written PHI the minimum necessary to fulfill job requirements?

  • If no, record details.

  • Is PHI secured properly?

  • If no, record details.

  • Do any employees leave the facility at any time with written or printed PHI?

  • If yes, record details.

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