ISMC EOC Checklist

• This is your EOC Rounds Report. Please respond within 15 days with corrections. Thank you: Ron Micue 550-3777

• Conducted on

  Date

• Prepared by Ron Micue

• Personnel: Angela Byrd, Gerry Augustin, Angela Gray, Becky Lewis

Building / Maintenance

• All construction, renovation and repair has PRA that is followed.

  Yes

  No

  N/A

• No mold growth in evidence?

  Yes

  No

  N/A

• Are all wall hangings secured?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sprinkler escutcheon are in place and properly seated and clean.

  Yes

  No

  N/A

• Plumbing escutcheons in place and no holes.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Do appropriate doors work and latch appropriately.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all public area electric breaker boxes locked?All Panel Boxes properly Labeled and intact.

  Yes

  No

  N/A

• Are Surge protectors properly approved and secured.

  Yes

  No

  N/A

• No building foam used in the area.

  Yes

  No

  N/A

• Fire extinguishers properly labeled, tested, inspected. Mounted between 5" From floor and no more than 5' to top of extinguisher.

  Yes

  No

  N/A

• No items mounted to wall that extend out more than 6" between 36" and 82" above floor in corridors.

  Yes

  No

  N/A

• Wall, floor and ceiling penetration properly sealed.

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

Employee Safety / Department

• Employees able to answer code questions appropriately?

  Yes

  No

  N/A

• Employees able to demonstrate proper infection control procedures.

  Yes

  No

  N/A

• Employees know proper procedures for various types of spills?

  Yes

  No

  N/A

• Are corridors clear of non-movable items and all carts on one side of corridor? Nothing but crash cart plugged in to outlets.

  Yes

  No

  N/A

• PPE boxes fully stocked?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is emergency equipment connected to red outlets?

  Yes

  No

  N/A

• Are patient records appropriately covered? HIPPA?

  Yes

  No

  N/A

• Pill crusher / Splitter clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Clean and soiled equipment appropriately bagged and stored?

  Yes

  No

  N/A

• Med cart/Drugs/Needles locked or secured?

  Yes

  No

  N/A

• Open solution bottles are appropriately dated?

  Yes

  No

  N/A

• Temp / Crash cart / negative pressure room logs Complete?

  Yes

  No

  N/A

• Is furniture without rips or tears and in good repair?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are splash zones appropriately separated and clear of clutter?

  Yes

  No

  N/A

• Infectious waste appropriately separated, sealed and not overflowing containers?

  Yes

  No

  N/A

• Nothing under sink other than cleaning supplies.

  Yes

  No

  N/A

• Refrigerator signs appropriate?

  Yes

  No

  N/A

• Eye wash if needed is there and being inspected?

  Yes

  No

  N/A

• No boxes on the floor?

  Yes

  No

  N/A

• Is storage >18” below sprinkler heads?

  Yes

  No

  N/A

• Are fire extinguishers & hose cabinets, med gas valves unobstructed?

  Yes

  No

  N/A

• No candles with wicks, or fragrance devices?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Employee purses secured?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Employee food and covered drinks in appropriate areas?

  Yes

  No

  N/A

• Are all chemicals/containers labeled?

  Yes

  No

  N/A

• Are clean / dirty supplies, equip., etc. appropriately separated in utility rooms?

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

IT

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

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

Housekeeping

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

  Yes

  No

  N/A

• Are floors clean and free of slip hazards?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• No excessive trash and linen in soiled utility rooms?

  Yes

  No

  N/A

• Additional Comments

  Yes

  No

  N/A

• Additional Comments.

  Yes

  No

  N/A

• name

  Sign