Hospital Safety Rounds

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fire Prevention

• Fire doors close and latch?

  Yes

  No

  N/A

• Smoke doors close?

  Yes

  No

  N/A

• Doors wedged?

  Safe

  At Risk

  N/A

• Exit signs illuminated?

  Yes

  No

  N/A

• Fire alarms accessible?

  Yes

  No

  N/A

• Fire extinguishers accessible?

  Yes

  No

  N/A

• Flammables stored appropriately?

  Yes

  No

  N/A

• Medical gas stored appropriately?

  Yes

  No

  N/A

• Appropriately Use of bulk medical gas storage rooms?

  Yes

  No

  N/A

• Smoke detectors unobstructed?

  Yes

  No

  N/A

• Sprinklers unobstructed?

  Yes

  No

  N/A

• Appropriate use of decorations?

  Yes

  No

  N/A

• Fire and smoke barrier penetrations sealed?

  Yes

  No

  N/A

Security Management

• Medications secured?

  Yes

  No

  N/A

• Syringes and needles secured?

  Yes

  No

  N/A

• Medical records secured?

  Yes

  No

  N/A

• Staff wearing IDs?

  Yes

  No

  N/A

• Belongings secured?

  Yes

  No

  N/A

Log Sheet Documentation

• Crash carts - daily?

  Yes

  No

  N/A

• Refrigerators - daily?

  Yes

  No

  N/A

• Fire Extinguishers - monthly?

  Yes

  No

  N/A

Safety Management

• Electrical cords and plugs in a safe condition?

  Yes

  No

  N/A

• Extension cords are not in use?

  Yes

  No

  N/A

• GFI outlet within 6' of water source?

  Yes

  No

  N/A

• Electrical panels accessible (3')?

  Yes

  No

  N/A

• Corridors unobstructed?

  Yes

  No

  N/A

• Emergency reference guides available?

  Yes

  No

  N/A

• Flashlights available?

  Yes

  No

  N/A

• Lifting equipment available?

  Yes

  No

  N/A

• Stairwells clear?

  Yes

  No

  N/A

• Step stools available?

  Yes

  No

  N/A

• Storage and mechanical rooms clean?

  Yes

  No

  N/A

Utilities Management

• Ceiling tiles stained?

  Safe

  At Risk

  N/A

• Oxygen shut off valves labeled?

  Yes

  No

  N/A

Clinical Equipment

• Current PM sticker?

  Yes

  No

  N/A

• Alarms disabled?

  Safe

  At Risk

  N/A

Hazardous Materials

• Appropriate use of utility rooms?

  Yes

  No

  N/A

• Sharps containers overfilled?

  Safe

  At Risk

  N/A

• PPE available?

  Yes

  No

  N/A

• Products properly labeled and stored?

  Yes

  No

  N/A

Infection Control

• Hand-washing observed?

  Yes

  No

  N/A

• Isolation precautions followed?

  Yes

  No

  N/A

• Linen covered?

  Yes

  No

  N/A

Waste Management

• Appropriate items in general trash?

  Yes

  No

  N/A

• Appropriate items in red bags?

  Yes

  No

  N/A

• Appropriate items in RCRA cans?

  Yes

  No

  N/A

• Appropriate items in sharps container?

  Yes

  No

  N/A

• Appropriate handling of waste streams?

  Yes

  No

  N/A

Recommended Follow-up?

• Follow-up for manager?

• Follow-up for Facilities?