Hospital Safety Inspection

• Audit Title

• Hospital Name/ Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions:
  -------------------------------------
  1. Answer "Yes", "No", "N/A" for the questions below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  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 - Storage is less than 18" from ceiling?

  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 - All wheeled equipment in corridor is "attended"?

  Yes

  No

  N/A

• 2.14 - Flammables, stored appropriately?

  Yes

  No

  N/A

• 2.15 - Penetrations to Walls / Ceilings / Floors, not present?

  Yes

  No

  N/A

• 2.16 - No unauthorized space heaters present?

  Yes

  No

  N/A

• 2.17 - No unauthorized heat producing equipment present (Toasters, etc)

  Yes

  No

  N/A

• 2.18 -Trash containers are no more than 32-gallons in capacity.

  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 - Electrical panels are accessible - 36" clearance around panels.

  Yes

  No

  N/A

4.0 - General Safety

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

  Yes

  No

  N/A

• 4.1 - Handrails are attached firmly to the walls?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4.5 - Stairwell 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 - Storage is at least 6" from the floor. No boxes on the floor?

  Yes

  No

  N/A

5.0 - Hazardous Marerial

• 5.1 - Eye wash station inspected weekly and documented?

  Yes

  No

  N/A

• 5.2 - High level disinfectant policy being followed - QC, documentation, etc?

  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 MSDS?

  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 condor table 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 - Lights in nearest stairwell operational?

  Yes

  No

  N/A

Completion

• Additional Comments:

• Audited by:

  Sign