Hospital Safety Inspection - Dietary Services

• Audit Title

• 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 - 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

• 2.19 - Fire extinguisher appropriate for the area?

  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

• 4.1 - Handrails are attached firmly to the walls?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4.5 - Storage Rooms clean and orderly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

5.0 - Hazardous Marerial

• 5.1 - Staff are able to obtain a MSDS?

  Yes

  No

  N/A

• 5.2 - Secondary container are labeled properly?

  Yes

  No

  N/A

• 5.3 - 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 - Doors with security hardware operate properly?

  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

8.0 - Other

• 8.1- Hair restraint is worn

  Yes

  No

  N/A

• 8.2 - All surfaces and floors are clean

  Yes

  No

  N/A

• 8.3 - All pieces of equipment are clean to sight and touch - equipment on serving line, storage shelves, cabinets........

  Yes

  No

  N/A

• 8.4 - Refrigerators / freezers are clean.

  Yes

  No

  N/A

• 8.5 - Can openers are clean

  Yes

  No

  N/A

• 8.6 - Garbage cans are clean

  Yes

  No

  N/A

• 8.7 - No evidence of pests is present

  Yes

  No

  N/A

Comments

• Additional Comments

• Surveyor's Signature

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• Please print a copy of this inspection and send a copy to the Safety Officer when all deficiencies have been corrected! Attach any work orders and/or purchase request.

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