Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Attendees

  • Facility Overview

Infection Control

  • Employee control: signs posted for Hand washing & Hygiene guidelines; Touch-less sanitizing stations, Faucets & Paper towels; Cleaning & Sanitizing schedule is followed?

  • Infection Control written policy and procedures for: Guests, Patients, Vendors or Customers? Controls may include: Entry protocols, Touch less Sanitizing stations that are secured & Self locking, Ventilation controls, PPE use, Staff safety training?

  • Management oversight of the Infection Control program?

  • Staff training is documented? Revised as needed?

  • Laundry. Sanitizing detergents; scrubs cleaned and laundered daily?

  • Stay home protocols for physically sick workers?

General Policies, Procedures & Training

  • Is there a comprehensive written Health, Safety and Environmental policy & procedures plan in place?

  • 1.H.14. Health and safety Self-Inspections are conducted at least Semi-Annually on each shift?

  • Written Emergency Procedures and Program for fires, bomb threats, natural disasters, utility failures, medical emergencies, violent or other threatening situations?

  • Records Management and Storage via keypad or electronic lock in separate rooms?

  • Personnel received documented competency-based training?<br>Upon hire and Annually - outline what type of training<br>in the following areas:<br>- Health and safety practices<br>- Identification of unsafe environmental factors<br>- Emergency & Evacuation procedures<br>- Identification & Reporting of critical incidents<br>- Medication management, if appropriate <br>- Reducing physical risks <br>- Workplace violence

  • Isolation Practices - Written Policy & Procedures?

  • Emergency Evacuation Written Program: Fire, Bomb Threats, Natural Disasters, Utility Failures, Medical Emergencies, Violent or Threatening Situations?

  • Required Postings posted?

  • Consumer Rights and Privacy Protection posters?

  • Medical Facility - First Aid/CPR/AED? Training?

  • Ventilator Competency Training?

  • HazCom: Policy, SDS management?

  • PPE training and refresher training as required?

  • Other?

General Safety

  • Facility is clean and organized?

  • Is adequate and functioning lighting provided in all areas?

  • Is the elevator(s) inspection certificate(s) up to date?

  • Elevator in good working condition?

  • Are work areas free of tripping hazards (cords, frayed carpet, free standing electrical fixtures, broken floor tiles, etc.)?

  • Is furniture (i.e. desks, chairs, filing cabinets) in safe condition?

  • Is overhead storage utilized properly?

  • Are filing cabinets free of items stored on top?

  • Are all stored items 18 inches below ceilings equipped with fire sprinkler heads?

  • Other Comments:

Fire & Electrical Hazards

  • Does the facility have a fire suppression system in place and what type: Automatic Fire Suppression System or Standpipe System?

  • Does the facility have Fire Extinguishers?

  • Are fire extinguishers adequate. 1 every 75' and located in high hazard areas?

  • Are fire extinguishers mounted with overhead locator signs?

  • Are fire extinguishers inspected annually by a Servicing provider?

  • Are monthly fire extinguishers inspections performed and inspections tags filled out?

  • Are employees trained in the PASS system for extinguisher use?

  • Smoke Detectors and Fire Alarms in working condition?

  • Are Fire Risers serviced annually by a servicing company?

  • Are all alarms functioning properly and routinely tested?

  • Are planned and/or unplanned fire evacuation drills routinely conducted?

  • Are electrical outlets adequate with no overloading, no missing grounding conductors or insulation damage?

  • Are power and extension cords in good condition, no missing grounding conductors or insulation damage?

  • Are circuits locations identified with a legend on the inside cover of the circuit panel doors?

  • Are circuits panels free of uncapped or exposed openings "voids" in the circuit panel?

  • Are 3' clearances maintained around all circuit panels & fire extinguishers?

  • Are electrical closets free of storage?

  • Other Comments:

General Environmental Control/Sanitation & Housekeeping

  • Carpeted floors are clean, no frayed edges or damage?

  • Are non-carpeted floors clean and in good condition?

  • Are warning signs used during mopping procedures?

  • Are floor mats in good condition, no curled edges, and not overlapped or placed on carpet?

  • Are restrooms clean and sanitary?

  • Are staff lounge and eating areas clean and sanitary?

  • Are drinking fountains clean and in good working order?

  • Facility is free of evidence of rodents, insects or vermin?

  • Are ceiling fan blades clean and in safe working condition>

  • Are walls and woodwork clean?

  • Are cleaning schedules followed for refrigerators, microwaves, stoves and other kitchen appliances?

  • Are Waste receptacles emptied nightly?

  • Are Biohazard wastes collected separately in BioHazard identifiable waste receptacles and stored properly for collection?

  • Other Comments:

Egress

  • Are alarms installed to restrict improper use of exits and are they tested to ensure proper function?

  • Are Evacuation routes Accessible & Understandable to: Persons served, Personnel & Other stakeholders including visitors?

  • Are all exit doors marked with illuminated exit signs or by external sources providing a minimum of 5 foot candles of light?

  • Are panic hardware (push bars) used at exit doors?

  • Are emergency and exit lights working properly?

  • Are doors designated to open outward?

  • Are Exit discharges clear of obstructions inside and outside?

  • Are Emergency Evacuation Plans posted and revised as needed?

  • Are hallways & stairways maintained free of obstructions?

  • Are stairways well lighted?

  • Are stairway handrails secured?

  • Are non-exiting doorways marked as "Not an Exit"?

  • Other Comments:

Maintenance

  • Are door closures and locks in good working order?

  • Are ceiling tiles intact, undamaged?

  • Is the building free from mold growth?

  • Are HVAC ducts and filters clean and serviced?

  • Are outside lights adequate and in working order?

  • Are gates and fences in good condition?

  • Is the building exterior in good condition?

  • Is the building roof in good condition, no evidence of leaks?

  • Sidewalks are free of raised adjoining slabs that are 1/4" or higher or have serious cracks or other damage?

  • Are parking lots free of potholes?

  • Are concrete tire stops and curbs in good condition?

  • Other Comments:

Playground

  • Swimming / Therapeutic Pools

  • Is the equipment age appropriate?<br>

  • Toddler - Under 2<br>* Climbing equipment under 32" high<br>*ramps<br>*Single file step ladders<br>*Spring rockers<br>*Swings with full bucket

  • Preschool - Ages 2-5<br>* Horizontal ladders less than 60" (ages 4-5)<br>*Ramps<br>*Merry-go-round<br>*Single file ladders<br>*Slides, Spiral up to 360 deg<br>*Spring rockers<br>*Stairways<br>*Swings-belt, full bucket seats(2-4 yrs) & rotating tire

  • Grade School - Ages 5-12<br>*Arch climber<br>*Cable walks<br>*Fulcrum seesaws<br>*Ladder (horizontal, rung & step)<br>*Stairways<br>*Swings - belt & rotating tire<br>*Vertical slide poles

  • Protective surface (impact attenuating) material in use beneath all equipment: sand, pea gravel, wood chips, untreated wood mulch, rubber mulch or unitary surfaces rubber flooring (grass and dirt are unacceptable)?

  • Loose fill material depths: Shredded rubber 6”, all others 9" deep and maintained level.

  • Are 6' clearances maintained around the entire equipment and 9' whenever adjacent equipment is more than 30" high

  • Are all components and fasteners tight, no protruding sharp edges (bolts should not expose more than two threads)?

  • Rusted or corroded metal?

  • Wood splitting or insect damage?

  • Are all "S" hooks and "C" hooks closed to within the thickness of a dime?

  • Head Equipment: Are there any openings between 3.5" and 9"?

  • Are there any suspended hazards (cables, wires, ropes or similar flexible parts suspended? between play units or from the ground to a play unit within 45 deg of horizontal?

  • Are protective guardrails and barriers in place on elevated platforms (designed to prevent falls and entrapment)?

  • Fall heights limited to:<br>a) Toddlers - 32"<br>b) Preschool - 60"<br>c) School age - 84"

  • Are slides provided with a hood or other channeling devise to properly position the user?

  • Is the playground free of trash, broken glass and debris?

  • Tripping Hazards:<br>a) Are anchoring devices below grade?<br>b) Are loose fill containment walls painted a contracting color?

  • Is there a sun exposure that can heat bare metal?

  • Is there a protective canopy offering adequate shade?

  • Is there adequate drinking water?

  • Is the playground supervised?

  • Overall General Comments or Concerns

The Risk & Loss Advisors team at Marsh & McLennan Agency LLC provides consultative services to help our clients reduce their total cost risk. Contact your Risk Consultant or Client Service Team for assistance. Any statements concerning legal matters are based solely on our experience as Risk & Loss Advisors and are not to be relied upon as legal advice, for which you should consult your own professional advisors. ̸ This is document is not intended to be taken as advice regarding any individual situation and should not be relied upon as such. Marsh & McLennan Agency LLC shall have no obligation to update this publication and shall have no liability to you or any other party arising out of this publication or any matter contained herein. Any statements concerning actuarial, tax, accounting or legal matters are based solely on our experience as consultants and are not to be relied upon as actuarial, accounting, tax or legal advice, for which you should consult your own professional advisors. Any modeling analytics or projections are subject to inherent uncertainty and the analysis could be materially affected if any underlying assumptions, conditions, information or factors are inaccurate or incomplete or should change. Copyright © 2021 Marsh & McLennan Agency LLC. All rights reserved. MarshMMA.com

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