HOSPITAL SAFETY ROUNDS

• Document No.

• Conducted on

  Date
• Location
  Address

• Prepared by

• Personnel

Fire Prevention

• Fire doors close and latch?

  Yes

  No

  N/A

• Fire doors are not blocked by carts, equipment, or materials?

  Yes

  No

  N/A

• Doors wedged (prevented from moving)?

  Safe

  At Risk

  N/A

• Fire exit signs illuminated and working properly?

  Yes

  No

  N/A

• Fire alarms accessible?

  Yes

  No

  N/A

• Fire extinguishers accessible and clear of obstructions?

  Yes

  No

  N/A

• Fire extinguishers has current inspection documentation?

  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 placement of decorations away from light fittings, heaters and any other heat sources?

  Yes

  No

  N/A

• Fire and smoke barrier penetrations sealed?

  Yes

  No

  N/A

Security Management

• All access secured (entrance/ exit?)

  Yes

  No

  N/A

• Medications secured?

  Yes

  No

  N/A

• Crash carts locked and in view of staff?

  Yes

  No

  N/A

• Syringes and needles secured?

  Yes

  No

  N/A

• Medical records secured?

  Yes

  No

  N/A

• Staff ID visible and worn properly?

  Yes

  No

  N/A

• Staff personal items are secured out of sight?

  Yes

  No

  N/A

• ID cards applied for visitors and contractors?

  Yes

  No

  N/A

• Security access log applied?

  Yes

  No

  N/A

• CCTV monitored by Security staff?

  Yes

  No

  N/A

• Security personnel or alternative security systems are utilized to restrict access to Critical Departments (e.g. ICU, NICU, PICU, LR/DR, OR, Others)?

  Yes

  No

  N/A

• Admitted patients with ID bands?

  Yes

  No

  N/A

• Are two identification bands/ tags available to newborns?

  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

• Fire Blankets - monthly?

  Yes

  No

  N/A

• Fire Box (cabinet and hose reel) monthly?

  Yes

  No

  N/A

• Fixed wet chemical extinguishing systems - monthly?

  Yes

  No

  N/A

• Isolation room monitors daily? (if not occupied, weekly)

  Yes

  No

  N/A

• Ambulance - daily?

  Yes

  No

  N/A

Safety Management

• Warning signs posted as appropriate in the hospital such as but not limited to, signs and warning lights for x-ray, warning signs for pregnant patients, wet floors during cleaning, no smoking signs, signs to restrict cellular phones in sensitive areas as appropriate, e.g. MRI or Critical Departments.

  Yes

  No

  N/A

• Directive signs posted as appropriate such as but not limited to directional signs, hospital services, signs to identify floor level at staircases and in front of elevators, signs to instruct staff, patients, and visitors in restricted areas, signs for population with special needs.

  Yes

  No

  N/A

• Electrical outlets are not damaged or loose?

  Yes

  No

  N/A

• Critical equipment is plugged into red outlet (emergency power)?

  Yes

  No

  N/A

• Electrical cords and plugs in a safe condition?

  Yes

  No

  N/A

• Extension cords are not in use?

  Yes

  No

  N/A

• No boilers or hazard materials in clinics/ offices/ departments?

  Yes

  No

  N/A

• Electrical panels accessible?

  Yes

  No

  N/A

• Corridors unobstructed, free of clutter and spills?

  Yes

  No

  N/A

• Emergency reference guides available?

  Yes

  No

  N/A

• Emergency light available?

  Yes

  No

  N/A

• All signages clear?

  Yes

  No

  N/A

• Staircase clear and well lighted?

  Yes

  No

  N/A

• Step stools/ ladders available to reach high places are in good shape?

  Yes

  No

  N/A

• Electrical cords, telephone and computer wires in area that might entangle feet?

  Yes

  No

  N/A

• Desk, chairs, furniture in safe/ good condition?

  Yes

  No

  N/A

• Presence of non-slipping floor's surfaces in patients bathrooms/ toilet?

  Yes

  No

  N/A

• Presence of functional call bell or system to call for help in patients room and bathroom?

  Yes

  No

  N/A

• Presence of bars/ hand rails to support patient inside the bathroom/ toilet?

  Yes

  No

  N/A

• Patient room furniture in safe/ good condition?

  Yes

  No

  N/A

Utilities Management

• Ceiling tiles are not stained (with any signs of water leakage)?

  Yes

  No

  N/A

• All lights are operational

  Yes

  No

  N/A

• Plumbing, faucets, toilets operational (no leaks)?

  Yes

  No

  N/A

• Oxygen shut off valves labeled?

  Yes

  No

  N/A

Clinical Equipment

• Does sampled equipment has current PM sticker?

  Yes

  No

  N/A

• User manual for the sampled equipment available in the department?

  Yes

  No

  N/A

• Does sampled equipment has alarms disabled?

  Yes

  No

  N/A

Hazardous Materials

• Appropriate use of utility rooms?

  Yes

  No

  N/A

• Doors to soiled/ clean/ hazardous materials rooms closed locked?

  Yes

  No

  N/A

• Sharps containers are no more than 3/4 full; syringes disposed of properly?

  Yes

  No

  N/A

• PPE available?

  Yes

  No

  N/A

• Staff are able to obtain MSDS?

  Yes

  No

  N/A

• Hazardous materials properly labeled and stored?

  Yes

  No

  N/A

Infection Control

• Hand-washing observed?

  Yes

  No

  N/A

• Isolation precautions followed?

  Yes

  No

  N/A

• Does clean linen covered?

  Yes

  No

  N/A

• Negative/ positive pressure monitor available (functional auditory alarm and visual display)?

  Yes

  No

  N/A

• Correct and complete ACH reading, negative/ positive pressure, temperature & humidity?

  Yes

  No

  N/A

• Negative/ positive pressure monitor not turned off even on weekends/ after duty hour?

  Yes

  No

  N/A

• Construction site compliance to safety & infection control requirements such as but not limited to safety permit, use of PPE, barriers, etc.

  Yes

  No

  N/A

• Privacy curtains changed?

  Yes

  No

  N/A

• For disposable curtains, change every 6 months or as needed?

  Yes

  No

  N/A

• For washable curtains, change every patient discharge or as needed?

  Yes

  No

  N/A

• OR/LR/DR/NICU/CSSD with traffic control and floor demarcation for unrestricted, semi-restricted, and restricted areas?

  Yes

  No

  N/A

• HEPA (High Efficiency Particulate Air) filters change every 6 months or as needed for all HEPA filter machines?

  Yes

  No

  N/A

• Walls, ceilings, and floor with visible holes/ opening/ cracks in Critical Departments such as OR and Isolation Rooms?

  Yes

  No

  N/A

Waste Management

• Appropriate items in general trash?

  Yes

  No

  N/A

• Appropriate items in yellow bags?

  Yes

  No

  N/A

• Appropriate items in red bags?

  Yes

  No

  N/A

• Appropriate items in sharps container?

  Yes

  No

  N/A

• Appropriate handling of waste stream (storage, collection, recycling, and disposal)?

  Yes

  No

  N/A