Audit

Previous department P.E Management survey

Have all previous non-conformities been corrected?

DNV 2014 Findings

Bio-hazard rooms are labeled and secured, including all soiled utility rooms and Scope decontamination rooms?

Eye protection is available in Soiled Utility rooms and decontamination rooms.

Appropriate use of clean and dirty storage (clean supply not in soiled areas), including all soiled utility rooms?

Flammables liquids - quantities greater than 1 gallon are stored properly in fire proof cabinet?

Eyewash station inspected weekly most current form is used (Form NC03100 - rev 01/21/14).

Junction boxes are covered?

Nothing is under the sink?

Storage in stairwell?

All department doors latch?

Paper Storage greater than 32 gallons are in proper rated room?

Electrical panels not blocked, schedule (legends) in place?

Emergency Management

Does staff know the Code Phrase for "FIRE"

Does the staff know where to find information on emergency codes and emergency plans?

Unit specific response plans are known by staff and available?

Emergency number stickers on all staff phones?

Staff conversant in RACE and PASS?

Staff displays knowledge of available evacuation equipment and how to obtain?

Add media
Environmental

High areas are free from dust?

Hopper rooms and chemicals are secured, cleaners are labeled, secured carts?

Floor areas are clean?

Portable fans if in use are cleaned?

Overall cleanliness of department is good?

Add media
Equipment and Supplies

Point of care – QC reagents expiration dates are compliant?

Integrity of product packaging is intact?

All Supply expiration dates are compliant?

Supply carts are dust free?

Add media
Hazardous Materials

Bio-hazard rooms are labeled and secured, including all soiled utility rooms and Scope decontamination rooms?

Hazardous "Waste" labels are in place where appropriate ?

Flammables stored properly, in fire proof cabinet?

Cleaners, chemicals are properly labeled and secured

Full and empty 02 tanks are separated and secured, limit 12 full cylinders in storage areas?

RMW is covered, not mixed and stored appropriately

Sharps containers are secured and not overfilled?

Eye protection is available to E.S staff?

Eyewash stations are inspected weekly?

Add media
HIPAA

Absence of HIPAA violations, no open charts?

Availability of designated bins to dispose of patient health information?

Gray and Blue bins secured?

Patient health information is in correct containers and not in dept wastepaper baskets?

Add media
Infection Control

Beverages or food at nurses station or on medication carts?

Linen carts are covered and nothing on top?

No cardboard boxes on floor?

Kitchen is clean, food is dated and not open?

Refrigerator temperature logs are current daily / values are in range? Temp issues are resolved?

Refrigerator log form is current (revised 2/24/2014) ?

Are temperatures complete and appropriate to Celsius and Fahrenheit ?

Blanket warmer Temperatures have been checked / within range

Torn or ripped mattress, cart pads, wheelchairs, task chairs?

Hand washing protocols followed and observed?

Product packaging integrity maintained?

Patient care equipment is clean and cleaned between patients, not dusty, free from tape?

artificial nails not seen?

Nothing under the sinks?

Add media
Life Safety

Oxygen, Med gas shutoff valves FE's, pull stations not blocked?

Corridor storage of equipment - plugged into outlets - moves in 20 minutes?

Fire extinguishers are charged and inspected within 30 days intervals?

No storage in the stairways?

Storage is below 18 inches of sprinkler heads?

All department Doors latch properly and doors are not propped or blocked?

Integrity of smoke and fire doors are intact with no paper or decorations?

Paper storage greater than 32 gallons are in rated rooms.

< 20% of wall covered (papers notes etc.)?

Auto shut off coffee pots, no toasters, no toaster ovens, other?

Lift equipment is stored properly / wheels are in the locked position?

Exit signs properly in place and fully illuminated?

Overall, Hallways are free from clutter?

Add media
Pharmacy issues

Medications are secured?

Pyxis machine, medication rooms, med carts, medication Refrigerator are secured?

Open medications are dated?

Code cart(s) log updated daily, secured and checksheet in use and in view?

Refrigerator temperature logs are current daily / values are in range? Temp issues are resolved?

Refrigerator log form is current (revised 2/24/2014) ?

Are temperatures complete and appropriate to Celsius and Fahrenheit ?

K solutions stored appropriately ?

Add media
Plant Operations

Electrical areas and panels are secured and accessible (not blocked by equipment), legends in place?

Walls free from needing patching or paint?

Ceiling tiles look good (not stained or broken)?

Lighting is adequate and covers are clean?

No broken or missing hardware?

Plumbing is intact with no leaks?

Ceiling HVAC vents clean?

Add media
Plant Mechanical Rooms

Flammable liquid storage?

Compressed gas storage?

Junction boxes are covered?

Chemicals labeled?

Machine guards in place?

Leaks?

Exit signs

Security and Safety

Staff wearing ID badges?

Have the security doors been comprised (combinations written in view, door propped, staff sharing combination)

Valuables are secured?

Add media
Supply/core areas

Soiled linen bags are not on floor?

Appropriate use of clean and dirty storage (clean supply not in soiled areas), including all soiled utility rooms?

Food trays are covered?

Broken or retired equipment is properly tagged as do not use, staff aware of procedures to remove any broken equipment?

Add media
Final Comments, Issues, Photos

Add media
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.