Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepares
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Location
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Personnel
1.0 - Previous inspection
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1.1 - Has the last inspection been reviewed?
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1.2 - Are there no outstanding actions?
2.0 - Fire Prevention
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2.1 - Door wedged or propped open, none found?
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2.2 - Fire doors are not blocked by carts, equipment, or materials?
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2.3 - Extinguishers is not missing damaged, or discharged?
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2.4 - Extinguishers has current inspection documentation?
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2.5 - Extinguishers clear of obstructions?
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2.6 - Sprinkler Heads/Smoke Detectors are clean & intact?
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2.7 - Indicator Lights are not obstructed?
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2.8 - Fire Exit signs are illuminating and working properly?
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2.9 - Fire Doors close and latch properly?
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2.10 - Storage is less than 18" from ceiling?
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2.11 - Doors to Soiled/Clean/Hazardous Materials Rooms closed locked?
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2.12 - Emergency Exit Corridors / Doors are clear?
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2.13 - All wheeled equipment in corridor is "attended"?
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2.14 - Flammables, stored appropriately?
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2.15 - Penetrations to Walls / Ceilings / Floors, not present?
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2.16 - No unauthorized space heaters present?
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2.17 - No unauthorized heat producing equipment present (Toasters, etc)
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2.18 -Trash containers are no more than 32-gallons in capacity.
3.0 - Electrical Safety
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3.1 - Electrical outlets are not damaged or loose?
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3.2 - Critical equipment is plugged into Red Outlet?
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3.3 - All extension cords are equipped with a ground prong?
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3.4 - All switches, receptacles and computer boxes have covers or plates?
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3.5 - Electrical panels are accessible - 36" clearance around panels.
4.0 - General Safety
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4.1 - Handrails are attached firmly to the walls?
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4.2 - All wheelchairs are in good repair and with both footrest?
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4.3 - Storage is at least 6" from the floor. No boxes on the floor?
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4.4 - Floors - tiles, carpet in good repair - no trip hazards?
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4.5 - Stairwell lights working?
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4.6 - Storage Rooms clean and orderly?
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4.7 - No items are being stored under the sinks?
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4.8 - Step ladders available to reach high places are in good shape?
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4.9 - No electrical cords, telephone and computer wires in area that might entangle feet?
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4.10 - Desk, chairs, furniture in safe condition?
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4.11 - Patient Room furniture in safe condition?
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4.12 - No evidence of food, drinks or eating occurring around computers or nurse station?
5.0 - Hazardous Marerial
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5.1 - Eye wash station inspected weekly and documented?
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5.2 - High level disinfectant policy being followed - QC, documentation, etc?
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5.3 - Medical gas cylinders are stored where full and empties are separated?
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5.4 - Medical gas cylinders are restrained properly in bins, racks, or hand carts?
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5.5 - Biohazard containers are stored properly?
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5.6 - Sharps boxes are no more than 3/4 full; syringe disposed of properly?
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5.7 - Staff are able to obtain a MSDS?
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5.8 - Secondary container are labeled properly?
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5.9 - Hazardous materials properly stored?
6.0 - Security Management
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6.1 - Employee personal items are secured out of sight?
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6.2 - Employee I.D. Badges visible and worn properly?
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6.3 - Confidential Materal secured /protected?
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6.4 - High risk patient's, equipment areas, hazardous material area rooms are secure?
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6.5 - Medications secured?
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6.6 - Doors with security hardware operate properly?
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6.7 - Code carts locked and in view of staff?
7.0 - Utilities Management
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7.1 - All lights are operational, no lights out?
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7.2 - Ceiling tiles, none discolored,/wet/damaged?
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7.3 - HVAC System - Air temperature within condor table range?
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7.4 - Plumbing, faucets,, toilets operational (no leaks)?
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7.5 - Ice machine clean and maintenance on schedule?
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7.6 - lights in nearest stairwell operational?
Comments
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Additional Comments
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Surveyor's Signature
