INTEGRIS BASS EOC - duplicate

• Document No.

• This is your EOC Rounds Report. Please respond within 15 days with corrections. Thank you: Roger Diller 580-213-2504

• Client / Site

• Conducted on

  Date
• Location
  Address

EC related items

• Ceiling tiles are in place, not moldy or broken.

  Yes

  No

  N/A

• Sprinkler escutcheon are in place and properly seated.

  Yes

  No

  N/A

• Are all stairwells free of stored items and no penetrations in walls?

  Yes

  No

  N/A

• Fire extinguisher, pull station and medical gas shut offs unobstructed?

  Yes

  No

  N/A

• Plumbing escutcheons in place and no holes or other than cleaning supplies in cabinet under sinks.

  Yes

  No

  N/A

• Are cables and wire neatly secured and out of the way under desks and work areas?

  Yes

  No

  N/A

• Is storage >18” below sprinkler heads?

  Yes

  No

  N/A

• Are floors clean and free of slip hazards?

  Yes

  No

  N/A

• Are all patients sleeping room doors unobstructed (doors can close & latch)? doors blocked open?

  Yes

  No

  N/A

• Are corridors clear of non-movable items and all carts on one side of corridor?

  Yes

  No

  N/A

• Are fire extinguishers & hose cabinets unobstructed? inspections current?

  Yes

  No

  N/A

• No candles with wicks, or fragrance devices?

  Yes

  No

  N/A

• Are all compressed gas tanks secured in a rack or holder? Less than 12 new cylinders in smoke zone?

  Yes

  No

  N/A

• Do all smoke & fire doors latch & close properly (top, bottom, and center)?

  Yes

  No

  N/A

• Appropriate temp, humidity and airflow relationships observed?

  Yes

  No

  N/A

• Is emergency equipment connected to red outlets?

  Yes

  No

  N/A

• Are EXIT signs illumination working? Egress route clearly marked?

  Yes

  No

  N/A

• Med cart/Drugs/Needles locked or secured?

  Yes

  No

  N/A

• Employee purses secured?

  Yes

  No

  N/A

• Are call cords in appropriate locations, appropriate length, and unobstructed?

  Yes

  No

  N/A

• Space heaters are in appropriate locations and of appropriate type?

  Yes

  No

  N/A

• Are patient records appropriately covered? HIPPA?

  Yes

  No

  N/A

• Are all public area electric breaker boxes locked?

  Yes

  No

  N/A

• Are all employees, physicians and contractors wearing ID Badges?

  Yes

  No

  N/A

• Are all chemicals/containers labeled?

  Yes

  No

  N/A

• Eye wash if needed is there and being inspected?

  Yes

  No

  N/A

• Additional Comments.

IC related items

• Refrigerator signs appropriate and appropriate items stored in refrigerator?

  Yes

  No

  N/A

• Soap, towels & hand sanitizer are readily available?

  Yes

  No

  N/A

• No boxes on the floor? No corrugated boxes in patient care area or food storage.

  Yes

  No

  N/A

• No excessive trash/linen in soiled utility rooms and labeled correctly?

  Yes

  No

  N/A

• PPE boxes fully stocked?

  Yes

  No

  N/A

• Temp / Crash cart logs Complete?

  Yes

  No

  N/A

• Are needle / sharp boxes secured and less than 2/3rds full.

  Yes

  No

  N/A

• Are all areas / rooms (fixtures/surfaces, vents) clean and free of dust accumulation?

  Yes

  No

  N/A

• All linen covered or in linen only room with door closed?

  Yes

  No

  N/A

• WOW and mouse appropriately cleaned without dust and spots?

  Yes

  No

  N/A

• Pill crusher / Splitter, glucometer and patient care equipment clean?

  Yes

  No

  N/A

• Washer/dryer disinfection between patient use documented? Lint filter cleaned?

  Yes

  No

  N/A

• Disinfection of community sinks,showers, tubs, etc. between patient use documented?

  Yes

  No

  N/A

• No expired medicines or supplies? Stock rotated to front?

  Yes

  No

  N/A

• 6 inch splash zone around sink maintained?

  Yes

  No

  N/A

• Refrigerators, microwaves etc. clean and free of defects?

  Yes

  No

  N/A

• Isolation carts adequately stocked and appropriate signage on door?

  Yes

  No

  N/A

• Are clean / dirty supplies, equip., etc. appropriately separated and bagged?

  Yes

  No

  N/A

• Employee food and covered drinks in appropriate areas?

  Yes

  No

  N/A

• Additional comments

• name

  Sign