• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Environment Free of Accidents - F323

  • Sidewalks free of major cracks and hazards?

Adequate and Comfortable Lighting in All Areas - F256

  • Ramps meet ADA requirements and rails are secure if present?

  • Glare minimized?

  • Bulbs operable?

  • Driveway free of major cracks and potholes?

  • Parking lot has adequate lighting?

  • Evacuation plans posted at each pull station showing location in building and nearest exit?

  • Exit Signs properly illuminated and visible through entire egress route?

  • Corridors are clear of equipment?

  • Doors leading to areas that pose a hazard to residents are locked at all times? All Doors identified with appropriate signs?

  • All electrical receptacles within six feet of a water source are GFI protected?

  • Only approved extension cords are used?

  • All plugs and cords on equipment are in good condition? No ground pins missing?

  • Water temperatures in resident areas not to exceed 120F?

  • Showers have anti-siphon back flow devices and non slip floors or mats?

Comfortable and Safe Temperature Levels - F257

  • Air temperatures between 71F & 81F?

Dispose of Garbage and Refuse Properly - F372

  • Dumpster/Compactor areas are clean?

  • Dumpsters are covered?

  • Waste is properly contained?

  • Infectious waste disposed and stored and properly labeled?

  • All waste scheduled for routine pick-up?

Infection Control - F441

  • All equipment is clean?

  • Ice machines have covered scoops?

Life Safety Code: Center must be Designed, Constructed, Equipped and Maintained to Protect the Health and Safety of Residents, Personnel and the Public - F454

  • Sprinkler System - All components clean and in good repair, replacement heads available and properly stored, wrench available for heads? All required inspections complete and reports available?

  • Flammable Products - Used and stored per manufacturers recommendations? Flammable storage locker clean, orderly and locked?

  • Hazardous Products - Used and stored per manufacturers recommendations, correctly labeled, protective equipment available?

  • Storage Areas - Clean, orderly, storage 6" above floor, 18" below ceiling, 18" below sprinkler heads, paper goods and food stored separate from chemicals?

  • Walls - Free from cracks, peeling paint, stains and cobwebs?

  • Fire Alarm System - Is in good repair, strobes are visible, horns sound? Smoke detectors are clean? All required inspections complete and reports available?

  • Fire Doors - Are labeled with fire rating, not warped or twisted, close properly, are positive latching and panic bars are in good working condition? Have gaps no more than 3/4 at the bottom and no more than 1/8 between doors when closed?

  • Smoke Barrier Doors - Are labeled with fire rating, not warped or twisted, close properly and have gap no more than 3/4 at bottom of door and no more than 1/8 between doors when closed? All Partitions through fire walls, floors and ceilings are sealed with fire rated material? Door stops are NOT in use?

  • Light Shields/Guards - All mechanical rooms, laundry, dietary and storage areas have light shields or guards to protect bulbs?

  • Clean Utility Rooms - Are clean, orderly and safe? No storage under sinks? Personal protective equipment is available?

  • Soiled Utility Rooms - Are clean, orderly and safe? No storage under sinks? Personal protective equipment available?

  • Janitors Closets - Are clean, orderly and safe? Personal protective equipment available?

  • Roof - Is free from bubbles, low spots, standing water, debris and leaks?

  • Gutters & Downspouts - Gutters and down spouts in good repair and drain properly?

  • Entrance - <br><br>Doors and hardware in good condition?<br><br>Drive-thru canopy clearance is marked?

Emergency Power - F455

  • An emergency electrical system must supply power adequate at least for lighting all entrances and exits, equipment to maintain the fire detection, alarm and extinguishing system and life support systems in the event of a normal supply interruption?

  • Generator is operable, belts good, water & oil levels ok?

  • Emergency circuits energized within 10 seconds of startup?

  • System is run weekly and under load monthly?

  • Logs are maintained?

  • Full load bank test completed annually and reports available?

  • Annual preventive maintenance performed and report available?

Mechanical Rooms

  • Boiler Rooms -Boiler in good repair, temp/pressure gauges in operating range, secure utility connections, circulating pumps operating? Room is clean and NOT used for storage? 3ft Clearance maintained around equipment?

  • Electrical / Mechanical Rooms - Are clean, safe and orderly? NOT used for storage? Equipment is in good operating condition?

  • Elevator Rooms - Are clean, safe and orderly? NOT used for storage? Equipment is in good operating condition?

  • Maintenance Shops - Is clean, safe and orderly, equipment in good repair and appropriate safety gear available?

  • Laundry Room - Washers clean, operate properly, belts good, doors and seals good, safety interlock working and free of leaks? Dryers clean, operate properly, belts good, doors and seals good, free of lint build-up in, on and around machines? Lint Screens cleaned every two hours and log maintained?

  • Nourishment Refrigerators - Gaskets in good repair and clean? Thermometer present and temperature logs maintained? Temp range is 34F to 45F?

  • Main Utility Shutoffs - Clearly labeled and location of shutoffs and procedures to operate shutoffs are in Emergency Preparedness Manual?

  • Grab Bars - Grab bars in toilet/shower areas are secure, clean and free of sharp edges?

  • Dietary - All equipment is clean and in good repair?

  • Resident Care Equipment - Lifts, scales, shower chairs, wheelchairs, side rails, beds etc. are clean, safe and in good working condition?

  • Central HVAC - Units are in good working order? Duct work is in good repair, sealed and insulated? Condenser/evaporator clean, fans operable, belts good, grills and filters clean? Filter logs maintained?

Resident Rooms - F457 - F462

  • Accommodates no more than four residents? Measures at least 80 sq ft per resident in multiple bedrooms and 100 sq ft in a single room? Has direct access to exit corridor? Assures full visual privacy? Has at least one window to the outside? Has a floor at or above grade level?

Toilet Facilities - F462

  • Each resident room is equipped with or located near toilet facilities?

  • Plumbing : Toilets and sinks are securely installed and caulked, free of leaks and operate properly?

Resident Call System - F463

  • The nurses station is equipped to receive resident calls through a communication system from resident rooms, toilets and bathing facilities?

Dining and Resident Activities - F464 - F465

  • One or more rooms dedicated to dining and activities?

  • Rooms are well lighted, well ventilated with non-smoking areas identified, adequately furnished and have sufficient space for activities?

Handrails - F468

  • Corridors are equipped with firmly secured handrails on each side?

  • Handrails are clean, secure and free of sharp edges and splinters?

  • Notes:

  • Inspected by:

  • Reviewed by:

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