MCL Environmental Rounds Non-Clinical Area

• Document No.

• Department

• Conducted on

  Date

• Prepared by

• Personnel

Fire Safety

• 1. Are exit doors and stairwells clear? <br>Main, corridor, and stairwell exits cannot be blocked.

  Yes

  No

  N/A

• 2. Are exit doors clearly marked "exit" and illuminated?<br>Check for burnt out bulbs.<br>EC.02.05.03

  Yes

  No

  N/A

• 3. Do fire doors latch properly?<br>Close the fire doors to see if they latch properly and see that there is no gap<1/8 inch in the middle.<br>EC.02.03.05<br>LS.02.01.10<br>NFPA 101<br>

  Yes

  No

  N/A

• 4. Are corridors and passageways free of obstructions? <br>The corridors can have mobile items (wheels on them) that are emergency needed items and are in use. (8 ft corridor and 6 in projections followed with nothing remaining in the hall <30 min)<br>EC.02.05.07<br>LS.02.01.20<br>LS.03.01.20<br>

  Yes

  No

  N/A

• 5. Are pull stations or fire extinguishers unlocked and obstructed?<br>There must be nothing to obstruct access.<br>EC.02.03.01<br>EC.02.03.05<br>NFPA 101<br>

  Yes

  No

  N/A

• 6. Are doors propped / held open? <br>Doorstops or homemade held open devices are not allowed.<br>EC.02.03.05<br>NPFA 105<br>NPFA 80<br>

  Yes

  No

  N/A

• 7. Are materials stored a minimum of 18 inches from sprinkler deflectors?<br>The distance between sprinkler deflector and stored items is 18 inches for sprinkled buildings. Check storage rooms, med rooms, patient rooms, etc.<br>LS.02.01.10<br>LS.03.01.35<br>

  Yes

  No

  N/A

• 8. Are stored rooms and equipment rooms free from clutter and unsafe conditions?<br>Make sure that items are not falling down or overstocked. Can you confirm there is no storage on the floor, including closet floors?<br>EC.02.06.01

  Yes

  No

  N/A

• 9. Do fire extinguishers have monthly and yearly checks?<br>

  Yes

  No

  N/A

• 10. Are linen, trash, and recycle bins < 32 gallons?<br>LS.02.01.70

  Yes

  No

  N/A

• 11. Sprinkler heads clean and free from debris?

  Yes

  No

  N/A

Fire Safety Staff Knowledge Questions

• 12. Does staff know the meaning of R.A.C.E.?

  Yes

  No

  N/A

• 13. Does staff know the location of exit route?

  Yes

  No

  N/A

• 14. Does staff know the meaning of P.A.S.S.?

  Yes

  No

  N/A

Utilities Physical Inspection

• 15. All lighting is operational?

  Yes

  No

  N/A

• 16. Can you confirm there is no storage under the sink?<br>UT 3. EC.01.01.01

  Yes

  No

  N/A

• 17. Is there at least 36” of clearance from electrical panels, fire and pull stations? Are electrical panels locked?<br>LS.02.01.20<br>NFPA 101<br>

  Yes

  No

  N/A

• 18. Is Med Gas, O2 shut off location labeled and clear of obstruction?<br>EC.02.05.07<br>EC.02.05.09<br>

  Yes

  No

  N/A

• 19. Are all mechanical, electrical, janitorial, communications rooms clean with no storage?

  Yes

  No

  N/A

Utilities Staff Knowledge Questions

• 20. Does staff know how to identify an emergency outlet? (Red outlets are fail-safe)

  Yes

  No

  N/A

Safety & Security Management Physical Inspection

• 21. Are floors and hallways in good condition?

  Yes

  No

  N/A

• 22. Walls are free from damage (chips, scuffs, or gouges)?

  Yes

  No

  N/A

• 23. Are ceiling tiles clean, stain free, and in good condition?<br>Indicate where these bad tiles are located in the comments.<br>EC.02.06.01

  Yes

  No

  N/A

• 24. Are heavy items stored at low levels or mid levels in storage?<br>Make sure heavy items are stored at waist level or lower shelves.

  Yes

  No

  N/A

• 25. Is there an Emergency Operations Plan available? Check area for red emergency procedures guidebook.

  Yes

  No

  N/A

• 26. Are staffs personal items properly secured?<br>RI.01.01.01

  Yes

  No

  N/A

• 27. Are all employees wearing their I.D badges properly?

  Yes

  No

  N/A

• 29. No space heaters present

  Yes

  No

  N/A

Safety & Security Staff Knowledge Questions

• 30. Does staff know what a tornado watch and a warning are? (Code gray and code black)

  Yes

  No

  N/A

• 31. Does staff know how to contact Security? 5550 non-emergent, 2222 for emergency

  Yes

  No

  N/A

Hazardous Materials & Waste

• 32. Are appropriate procedures, instructions, or directions available for obtaining MSDS? MCL intranet page, HAZSOFT link.

  Yes

  No

  N/A

• 33. All chemicals contain a manufactures label? Ensure all containers have a label.<br>EC.02.02.01<br>EC.04.01.01

  Yes

  No

  N/A

Medical Equipment Physical Inspection

• 34. Does equipment have cords in good condition (no cracks or exposed wires)?

  Yes

  No

  N/A

• 35. Are all medical equipment inspection tags current?<br>EC.02.04.01<br>EC.02.04.03<br>

  Yes

  No

  N/A

Infection Control Physical Inspection

• 36. Hand-washing soap dispensers are in place and filled?

  Yes

  No

  N/A

• 37. Alcohol hand sanitizers are in place and not expired?

  Yes

  No

  N/A

Notes or work orders needed: