• Document No.

  • This is your Clinical EOC Report. Please respond within 15 days with corrections. Thank you: Scott S. Tulane 405-657-3131

  • Department Surveyed:

  • Conducted on

  • Prepared by:

  • INTEGRIS Health Edmond 4801 Integris Parkway Edmond, Oklahoma 73034
  • Personnel: Troy Branstetter, Scott S. Tulane, Patti Newberry


  • Hallways and stairs are free of obstructions?

  • Elevator doors open / close properly

  • Walls and ceilings are free of major damage and stains?

  • Floors have no damaged carpet or tile, slippery spots, or tripping hazards

  • Ventilation grills are clean and unobstructed?

  • Handrails are present and secure in patient rooms, bathrooms, and stairwells

  • Comments:


  • All fire extinguishers have been inspected monthly

  • Fire extinguishers / pull stations are easily accessible?

  • Are EXIT signs illumination working and unobstructed?

  • Self-closing doors are not obstructed or held open with wedges, chairs, etc.?

  • When fire doors are allowed to close, they close all the way and latch shut?

  • Comments:


  • Only hospital approved extension cords are in use and are not trip hazards or untidy?

  • The outside of equipment and power cords and plugs have no visible damage?

  • Utility panels are free from obstructions?

  • Electrical outlets are free from damage

  • Medical equipment is properly tagged , PM's have been conducted within the last 12 months?

  • Gas valves and panels are properly labeled and functioning?

  • Comments:


  • Equipment is stored and stacked properly with 18 inches of clearance below the sprinkler heads?

  • Boxes or supplies are kept at least 6 inches off of the floor?

  • Gas cylinders are secured in carts, stands, or chained to the wall

  • Comments:


  • Electrical closets and hazardous areas are kept locked?

  • Personal items (purses, wallets, keys, etc.) are stored out of sight?

  • Doors with extra security devices, such as card readers and key pads, are always allowed to close and lock?

  • Employees are wearing photo ID's (face forward)?

  • Comments:


  • Isolation rooms are properly labeled, functioning, and supplies are readily available outside the door?

  • Department is clean and dust free?

  • Are needle / sharp containers less than 2/3rd full and secured to the wall, cabinet, or cart?

  • Waste containers are available to separate general waste from infectious waste?

  • Evidence of hand hygiene in ( ) # of employees out of ( ) # observed?

  • Refrigerator clean and all contents within manufactures expiration date?

  • Microwave oven is clean

  • Personal Protective Equipment is readily available where appropriate?

  • No evidence of storage under the sinks

  • Comments:


  • Comments:


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