Staff Knowledge

Staff able to demonstrate knowledge and skill of their role and expected participation in the safety management program?

Staff able to demonstrate knowledge and skill of their role and expected participation in the security management program?

Staff able to demonstrate knowledge and skill of their role and expected participation in the hazardous materials and waste management program?

Staff able to demonstrate how to pull an MSDS for chemicals used?

Staff able to demonstrate knowledge and skill of their role and expected participation in the emergency preparedness program?

Staff able to demonstrate knowledge and skill of their role and expected participation in the life safety program?

Staff able to demonstrate knowledge and skill of their role and expected participation in the utilities management program?

Staff able to demonstrate knowledge and skill of their role and expected participation in the medical equipment management program?

How are equipment malfunctions reported?

Staff able to demonstrate how to pull policies and procedures?

How are you trained to operate equipment? What do you do if you are unsure of proper function?

Emergency procedures readily available and staff knowledgeable of location and contents?

Staff able to locate nearest fire extinguisher, fire pull, gas shut-off?

Staff able to demonstrate proper function of Fire Enunciator Panel?


All employees have employment badges on and visible?

All non-employes individuals have appropriate badge on and visible?

All confidential/PHI is secured without being visible?

All areas free from odors?

Sharps containers locked and secured to wall/cart?

Equipment with current Biomed tags?

Child-safe outlet protectors in use?

Emergency carts (crash cart, Broselow cart, MH cart) all locked with current documentation?

Daily/monthly checklists present and up-to-date for all emergency carts?

All medication areas have current expiration date checklists complete?

All supply areas have current expiration date checklists complete?

Temperature and humidity logs complete for OR area?

Bi-monthly cleaning checklists complete for all areas?

Refrigerator temperature logs complete and up-to-date?

Medication refrigerator: No food items, medications only, expiration dates checked, proper storage of medications?

Patient food refrigerator: No staff items, expiration dates checked, all items labeled with expiration dates, temperature monitored?

All blanket and fluid warmers temperature checks maintained? Fluids labeled with expiration date?

Tissue Freezer: Temperature checks complete and up-to-date, AATB/FDA documents complete and up-to-date, tissue logs complete and accurate, implant log complete and accurate?

Blood Glucose testing logs complete?

Blood glucose user manual present?

Gas cylinders all labeled and tagged appropriately? Removed when empty?

Gas cylinders stored upright and secured?

Gas cylinder gauges in proper working condition?

Are all furniture in proper condition?

Staff appears to work ergonomically safe?

Exit doors unobstructed?

Fire doors free of decorations?

Hallways free of equipment? Corridors clear and uncluttered? 8 feet clearance required; may store temporary items on ONE SIDE of hall for short period.

Evacuation maps posted next to fire pulls?

Exit signs functioning and visible from all areas?

All fire extinguishers inspected monthly?

Fire extinguishers not blocked by equipment?

All doors are positively latching? No wedges used?

No fire wall penetrations present?

No items stored closer than 18" from ceilings?

Cardboard present in restricted areas?

All eyewash stations tested and flushed daily/weekly?

Gluteraldehyde logs complete and accurate?

All chemical containers properly labeled and stored at eye level or lower in order to avoid eye splashing?
Labels must include: full name of product, hazard warnings, name, address, emergency phone # of manufacturer

Spill kits (formaldehyde, body fluid, mercury) present and available 24 hours/day?

All flammable items stored appropriately in fire cabinet?

Storage areas free of clutter? Items not stored on floor? No cardboard present?

Cord management complete in all areas - no tripping or tangling hazards?

All electrical equipment in good condition (cords, plugs, etc.)?

Hot water temperature 120 degrees F or less?

Walls free of chips and are kept cleaned?

Stairwells accessible and free of obstruction?

Corridor handrails intact and not loose?

All exit doors open from the inside?

Bathroom grab bars intact and not loose?

Nurse call system is within reach of patient? In bathrooms, pull cords reach the floor, but do not drag on floor?

Proper use of bed rails observed?

Patient beds/stretchers in lowest position when unattended?

Medication Areas

Medication areas locked with restricted access?

Medication preparation area clean and unobstructed?

No expired medications present?

Stored appropriately - no mixing of different administration routes?

Look-Alike Sound-Alike practices observed?

All medications labeled appropriately?

National Patient Safety Goals

2 patient identifiers used when administering medications/blood, specimens, and while providing treatment?

All specimens are labeled in the presence of the patient?

All medications are labeled appropriately on and off of the sterile field at all times when removed from the original medication container? Contains medication name, strength, quantity, diluent, expiration date and time if applicable.

All medication containers are verified both visually and verbally by 2 individuals when the person preparing is not the person administering?

Unlabeled medications are discarded immediately?

Medications in all areas are reviewed by entering and exiting staff when changing patient care providers?

Physicians mark the surgical/procedural sites?

Time-Outs are performed per policy?

Infection Control

Stethoscopes cleaned after every use?

Proper keyboard and mouse cleaning after every patient?

No items stored under sinks (cleaning supplies acceptable - no cloths/paper towels)

Exposure Control Plan accessible to staff 24 hours/day and up to date?

Scrub sinks clean and working properly?

All rooms clean without dust?

Patients are educated upon admission on surgical site infection prevention?

Ceilings free of stained tiles?

All floors appropriately maintained?

No boxes/items directly on floor?

PPE's available is all areas? Bay drawers, Sub-Steriles, ERCC, Procedure Rooms, Soiled Workrooms?

Red biohazard bags available in all areas?

Sharps containers not more than 2/3 full?

Red hazardous bins are secured and covered properly?

Standard precautions observed at all times? View each individual area for repeated behaviors/practices. To include use of PPE's, handwashing, cleaning practices.

Blood-Borne pathogens requirements observed? To include no recapping of needles, standard precautions, sharps safety

No food present in patient care areas?

All employee drink containers covered?

All linens stored appropriately (covered)?

All autoclaves/sterilization logs complete and accurate?

Clean/dirty areas appropriately separated and maintained?

Appropriate flow maintained clean to dirty?

All air vents free from dust/dirt?

Airflow properly maintained?

Hand hygiene practices in compliance with requirements?

Alcohol hand rubs are well stocked?

Sink areas well stocked?

No staff with artificial nails?

No razors present in facility?

Mattresses and pillows all free of tears?

Staff able to verbalize contact time for cleaning chemicals?

No overflowing trash?

Solid surfaces is present on all bottom shelves/carts?

All supplies stored appropriately?

Patient care items kept in clean areas away from possible contaminants?

All control indicators dated when opened (system 1e, blood glucose, etc).

Blood glucose machine cleaning documented?


Weather radios turned on, adequate volume and functioning?

Walkie-talkies plugged in, visible and easily accessible?


Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.