Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
GENERAL SAFETY
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Hallways and stairs are free from obstructions?
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Do the elevator doors open close properly?
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Are the walls and ceilings free of major damage and stains?
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Do the floors have damaged carpet or tile, slippery spots, or tripping hazards?
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Are the ventilation grills clean and unobstructed?
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Are the handrails present and secure in the patient rooms, bathrooms, and stairwells?
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Are the crash carts inspected and up to date?
FIRE SAFETY
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Have the fire extinguishers been inspected monthly?
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Are the fire extinguishers and pull stations easily accessible?
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Are the EXIT lights unobstructed and lit?
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Do the self closing doors close all the way and latch?
GAS / ELECTRICAL SAFETY
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Only hospital approved extension cords are in use and are not a trip hazard, or untidy?
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The outside of equipment and the power cords / plug have no visible damage?
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Are the utility panels free from obstructions?
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Are the electrical outlets free from damage?
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Is the medical equipment properly tagged and PM'd within the last (12) twelve months?
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Are the medical gas valves properly labeled and functioning?
STORAGE
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Are supplies properly stored and has an 18 inches of clearance under the sprinkler heads?
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Boxes and supplies are kept at least 6 inches off of the floor?
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The bottom shelf of carts have a liner to prevent splashing onto the supplies or equipment?
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The gas cylinders are secured in carts, stands, or chained to the wall?
SECURITY
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The electrical closets, data closets, and hazardous areas are kept locked?
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Personal items (purses, wallets, keys, etc.) are stored and kept out of sight?
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Are employees wearing their photo identification badges, facing forward at chest level?
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Doors with extra security devices (such as card readers or keypads) are always allowed to close and lock?
INFECTION CONTROL
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Are the isolation rooms properly labeled, functioning, with supplies readily available outside of the door of the isolation patient
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Is the department clean and dust free?
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Are the SHARPS containers less than 2/3 rds full and secured to the wall, cabinet, or cart?
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Is there evidence of hand hygiene practiced and witnessed in the work or clinical area? ( ) out of ( ) observed.
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Is the medication preparation area clean and unobstructed with signage visible?
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Are sinks clear of clutter or supplies at least 12 inches?
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Are patient refrigerators clean and all contents within the manufactures expiration date?
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Are staff refrigerators clean and all contents within the manufactures expiration date?
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Are the microwave ovens clean?
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Is personal protective equipment readily available where and when appropriate?
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Is there any evidence of storage under the sinks?
COMMENTS
SIGNATURE
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