Title Page
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Site conducted
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Site
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Area Name
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Location
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Inspection Date
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Inspectors
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Document No.
Previous Year's Inspection
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The previous year's inspection has been reviewed.
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The previous year's inspection findings were resolved.
Fire Safety
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Fire response devices were unobstructed, such as hose cabinets, extinguishers, pull stations, electrical panels, gas shutoffs.
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Fire extinguisher inspection tags identify monthly checks.
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Exit doors (both hinged and sliding doors) were unlocked or equipped with push-open function.
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Fire doors were kept closed or magnetically held open (not propped open with wedges).
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Fire doors were in good condition and closed properly.
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Fire doors were not breached by linens.
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Exit signs were visible and in good condition (red EXIT or green and white person running).
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Are sprinkler heads clean and escutcheon plates in place (this is the metal ring surface around the sprinkler that is flush on the ceiling)
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Stairways and exit routes were free of storage.
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Other fire hazards
Electricity and Small Appliances
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All switches and receptacles were observed to have plate covers.
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Wires were positioned so as not to be a trip hazard
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Electrical cords, plugs and switches were observed to be in good condition.
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Extension cords were not attached to other extension cords or splitters.
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Small appliances were observed to be safe and in good condition.
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Heating devices such as microwaves, toasters and heaters did not have paper in or around them.
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Other electrical/appliance concerns
Hygiene, Cleanliness - Air, Water, Food and Drink
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No ventilation concerns noted.
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Signage for separation of food and drink from hazardous chemicals, drugs or biohazards.
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Cleanliness concerns such as dust and residue, blood or bodily fluids.
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Water taps working properly; no reported water concerns (quality, temperature).
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Other hygiene hazards
WHMIS/Chemical Safety
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Staff are using only hospital cleaning products.<br>
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Hazardous chemicals and flammables are labeled and stored properly.
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PPE is available for pouring/decanting chemicals.
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Gas cylinders are secured safely.
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Emergency eyewash is identifiable, functioning, unobstructed, and has a test history posted.
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Other chemical safety concerns
Scents / Chemical Sensitivity
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Concerns with scented products (personal perfume, cleaning scents, etc)
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Latex products observed
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Other scent concerns
Patient Care
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PPE supplies are stocked outside patient rooms
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Sharps containers are in place and an appropriate size.
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Sharps containers are not full.
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Medical equipment is in good condition.
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Other patient care safety concerns
Supply Room
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Supply room/Logi D cart has no materials on top of cabinet.
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Top storage drawers work properly and have no heavy contents.
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There are no trip hazards or blind sightlines in the room.
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Other supply room concerns
Soiled/Waste Room
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Floor of waste room is clear of clutter.
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Storage carts/bins are not overloaded.
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Other waste room concerns
Falls Prevention
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Wet floor signs were safely stored or used appropriately.
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No observed unsafe wet floors.
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No clutter, garbage or obstructions on the floors.
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Equipment and legs (of stretchers, printers, IV poles) are safely stored out of the way in high-use areas.
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Wiring and cables were observed to be safely out of worker reach, including under desks.
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Footwear was observed to be appropriate.
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Public walkways and entrances are appropriate.
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Other falls concerns
