MCMC Monthly Departmental Safety Audit

• Location/Department

• Conducted on

  Date

• Prepared by

• Personnel Assisting

SAFETY MANAGEMENT

• Housekeeping closets are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Soiled utility rooms are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Clean utility rooms are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Oxygen storage rooms are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Medication rooms are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Utility closets are locked (EC.02.01.01 EP8)

  Yes

  No

  N/A

• Handrails are firmly attached to the walls (EC.02.01.01 EP3)

  Yes

  No

  N/A

SECURITY MANAGEMENT

• All staff members are wearing hospital identification badges (EC.02.01.01 EP7)

  Yes

  No

  N/A

• Your department has flashlights that work properly and are stored in an easily accessible location. (EC.02.02.09 EP2)

  Yes

  No

  N/A

• Clean sharps are secured and locked in cabinets, carts, or locked containers (EC.02.01.01 EP3)

  Yes

  No

  N/A

• Doors that should be locked are locked to control access into your department from patients and visitors (EC.02.01.01 EP3)

  Yes

  No

  N/A

• Childproof protective outlet covers are located in outlets in lobbies, hallways, and public gathering points

  Yes

  No

  N/A

• All medications are secured (MM.03.01.01 EP3)

  Yes

  No

  N/A

• Medical records cannot be seen from the "public's" point of view at the workstations/nurse's station

  Yes

  No

  N/A

• Signage in your department is in good condition and reflects the current operational practices for your unit (LD.03.04.01 EP3)

  Yes

  No

  N/A

• Staff's belongings and personal items are not easily accessible by patients and visitors (EC.02.01.01 EP3)

  Yes

  No

  N/A

HAZARDOUS CHEMICALS AND WASTE MANAGEMENT

• Hazardous chemicals in your department are stored appropriately (EC.02.02.01 EP5)

  Yes

  No

  N/A

• Medical waste containers are not full and labeled with the date installed and expired (NOT MORE THAN 90 DAYS) (EC.02.02.01 EP12)

  Yes

  No

  N/A

• Sharps containers are not full in your unit. If they are please change these appropriately (IC.02.01.01 EP1)

  Yes

  No

  N/A

INFECTION CONTROL

• Staff's food and beverages are not present in patient care areas (LD.04.01.01 EP2)

  Yes

  No

  N/A

• Personal Protective Equipment (PPE) is adequately stocked and readily available; in good condition; and appropriate for your department (IC.01.02.01 EP3)

  Yes

  No

  N/A

• Linen carts are covered with impervious covering (IC.01.02.01 EP4)

  Yes

  No

  N/A

• Single soiled linen bags are not overfilled (EC.02.01.01 EP3)

  Yes

  No

  N/A

• Trash bags are not overfilled (EC.02.01.01 EP3)

  Yes

  No

  N/A

• No items are stored under sinks (LD.04.01.01 EP2)

  Yes

  No

  N/A

• Storage is at least 6" from the floor and no boxes are stored on the floor (IC.01.02.01 EP3)

  Yes

  No

  N/A

• Areas are clean, sanitary, and free from reoccurring offensive odors. These include lighting, vents, surfaces, walls, ceilings, and equipment (EC.02.06.01 EP20)

  Yes

  No

  N/A

• Paper towels are placed in the dispenser not placed on the countertops (NPSG.07.01.01 EP1)

  Yes

  No

  N/A

• Alcohol based hand rubs are not empty and dispensing properly (IC.01.02.01 EP3)

  Yes

  No

  N/A

• There are no rips or tears on vinyl covered patient equipment or chairs. (Stretchers, treatment table coverings, ect) (EC.02.06.01 EP26)

  Yes

  No

  N/A

LIFE (FIRE) SAFETY MANAGEMENT

• Hallways are free from all obstructions. This does NOT include crash carts, isolation carts, and equipment in use (this means accessed at least every 30 minutes or often) (LS.02.01.20 EP13)

  Yes

  No

  N/A

• Stored items are more than 18" from the bottom of the ceiling in any room (LS.02.01.35 EP6)

  Yes

  No

  N/A

• Sprinklers and smoke detectors look free from dust (LS.02.01.35 EP5)

  Yes

  No

  N/A

• Fire extinguishers and pull stations are not blocked at all times (LS.02.01.35 EP8)

  Yes

  No

  N/A

• Fire extinguishers have been inspected this month (Lock at the backside of the tag) (EC.02.03.05 EP15)

  Yes

  No

  N/A

• Emergency Exit signs are clearly visible and working properly (evenly illuminated) (LS.02.01.20 EP13)

  Yes

  No

  N/A

• Fire doors are not blocked from shutting and latching properly (LS.02.01.30 EP11)

  Yes

  No

  N/A

• Doors are not wedged open (LS.03.01.20 EP8)

  Yes

  No

  N/A

• Flammable decorations like natural Christmas trees are not present in the hospital at any time (LS.02.01.70 EP1)

  Yes

  No

  N/A

UTILITY SYSTEMS MANAGEMENT

• Sinks, showers, toilets, and water lines are in good repair (not leaking and working appropriately) (EC.02.06.01 EP1)

  Yes

  No

  N/A

• Extension cords are not used in your department (EC.02.03.01 EP1)

  Yes

  No

  N/A

• Electrical outlets are not damaged or loose and have covers. This also includes switches, and network connections (EC.02.03.01 EP1)

  Yes

  No

  N/A

• Electrical panels are labeled as such and locked (locked in public areas) (EC.02.05.01 EP8)

  Yes

  No

  N/A

• Medical gas shut offs are properly labeled and clear of obstructions (EC.02.05.9 EP3)

  Yes

  No

  N/A

MISCELLANEOUS

• Are there any slip and fall hazards in your department? (EC.02.01.01 EP3)

  Safe

  At Risk

  N/A

• Any other concerns for your unit or area of inspection?

• Please add and additional photos during this audit that are of a concern but do not fit into any of the above categories.

  Media

END OF SURVEY

• Please complete this survey once a month. When complete, sign the document electronically and email it to reportit@mcmcbr.com

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