IC Departmental Rounding Sheet 2024

Title Page

Site conducted
Conducted on
Prepared by
Location

Are items stored at least "36 from electrical panels
No items stored within 18" of ceiling
Are electric panels switch labels accurate and are all spares in the off position?
Are all mechanical and electrical rooms clean and have no storage? Indicate which rooms are not clean in the notes section
Are medical gas zone shut off valves accessible and unobstructed?
Are medical gas zone shut off valves properly labeled for area served?
Do clean utility, sterile storage, medication rooms, and other clean/sterile areas have positive air pressure to the corridor/adjacent areas?
Do soiled utility, trash, hazardous waste, and other dirty room shave negative air pressure to the corridor/adjacent areas?
Clean utility rooms contain only clean/sterile items?
Soiled utility rooms contain contaminated/soiled items only? Door is locked?
All clean supplies stored off of the floor?
Are supplies within expiration dates?
Is clean linen covered?
Is clean linen kept separate from the dirty linen disposal?
Are patient food refrigerator logs maintained and up to date? Are temperatures within range?
Are patient food freezer logs maintained and up to date?
Are patient food freezer logs maintained and up to date? Are patient food freezer temperature within range?
Are medicines and food stored in separate refrigerators?
Patient food items have expiration dates and are not expired?
The only items located under sinks are items allowed by policy?
Return and supply air diffusers are free from dust?
Countertops in good repair with no chips or missing laminate?
Furniture is in good repair and not dirty or soiled?
All Multidose medication vials are dated with a 28 day expiration date?
Glucometers clean; Glucometer controls are dated with correct expiration date?
No stained ceiling tiles noted
No corrugated boxes noted in area
No call bells looped around bars?
Crash cart logs current with dates checked
Crash carts plugged into red plug
Egress hallways are free of clutter
All oxygen cylinders secured
Oxygen cylinders (full or partial) are kept separated from empty cylinders? If oxygen cylinders are kept in a supply room is a sign on the door to signify oxygen stored?
No expired biomed stickers found

Department/Unit:

Floors clean; wet floor sings placed appropriately
Hallway AC grills and returns clean without dust buildup; no horizontal dust
No wet ceiling tiles
Linen carts covered

Central Station/Desk

No unlabeled/unattended specimens
No food or beverages in undesignated areas
No soiled equipment on counters
WOWs, desk computers, keyboards clean top to bottom
No employee food or drinks on WOWs or outside designated "drink" area
No unattended medications or syringes on WOWs
No open unlabeled medication vials on WOWs

Clean Supply Storage

All supplies stored in orderly fashion without danger for contamination
Solid surface on bottom rack of supply racks
Packaging not compromised by storage space, esp. sterile packaging
Supplies not stored within 3 feet of water source or 18 inches from sprinkler head
No corrugated boxes in room
No soiled supplies or equipment in room
No "expired" supplies
No storage directly on floor
Clean equipment marked as "clean" per policy

Clean Linen Storage

Clean linen carts: linen covered, no items on top of cart, no soiled items

Patient Nutrition Room

Patient non-refrigerated nutrition stocked in orderly fashion and without compromise to packaging
No corrugated boxes in room
No insects
Ice machine clean
Coffee makers clean