MCMC Quarterly Facility Safety Audit

• Quarter # and Location

• Conducted on

  Date

• Prepared by

• Personnel Assisting

BUILDING SURVEYED

• Building Name

  Hospital

  Medical Arts Building

  Professional Office Building

  Canadian Lakes

  Big Rapids OB/GYN

DEPARTMENTAL MONTHLY SAFETY ROUNDS

• Departments in this building have completed the monthly safety rounds and have submitted these to the safety officer for this quarter

  Yes

  No

  N/A

SAFETY MANAGEMENT

• Staff quickly respond to patient call lights. Pull cords are no more than 6" off the floor. Test a patient alarm. Record the time for staff to respond. Reset the system to normal use after the test

  Yes

  No

  N/A

• Staff know where lifting equipment is located and how to properly know how to use it. (Gait belts, Hoyer Lifts, ect)

  Yes

  No

  N/A

• Ask staff what they would do if the injured themselves, needle stick, slip and fall, back injury, or other injury

  Yes

  No

  N/A

• Housekeeping closets are locked (Randomly select a room to check)

  Yes

  No

  N/A

• Soiled utility rooms are locked. (Randomly select a room to check)

  Yes

  No

  N/A

• Clean utility rooms are locked (Randomly select a room to check)

  Yes

  No

  N/A

• Oxygen storage rooms are locked (Randomly select a room to check)

  Yes

  No

  N/A

• There are no more than 12 oxygen tanks stored together (Randomly select a room to check)

  Yes

  No

  N/A

• The empty and full oxygen tanks stored in separate racks (Randomly select a room to check)

  Yes

  No

  N/A

• Medication rooms are locked (Randomly select a room to check)

  Yes

  No

  N/A

• Utility closets in public areas are locked (Randomly select a room to check)

  Yes

  No

  N/A

• Bio-Hazard room is secured at all times

  Yes

  No

  N/A

RADIATION SAFETY

• Medical Imagining staff members are wearing dosimeters

  Yes

  No

  N/A

SECURITY MANAGEMENT

• Ask if staff feel safe working at MCMC. How could they feel more safe?

  Yes

  No

  N/A

• All staff members are wearing hospital identification badges

  Yes

  No

  N/A

• Doors that should be locked are locked to control access into your department from patients and visitors

  Yes

  No

  N/A

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

  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

HAZARDOUS CHEMICALS AND WASTE MANAGEMENT

• Does staff know where the closest eyewash station is located? Have them describe the steps to use it appropriately. Verify the weekly flow test (located in EVS office)

  Yes

  No

  N/A

• Staff know the location of hard copies of MSDS as well as how to access the MSDS database from the Pulse

  Yes

  No

  N/A

INFECTION CONTROL

• Ask staff the wet dwell time to the:<br>green top wipes (10 mins)<br>red top wipes (1 min)

  Yes

  No

  N/A

• Verify that negative and positive pressure rooms are functioning according to the monitors on the wall as well as a manual test is conducted on each applicable room.

  Yes

  No

  N/A

• Linen and supply carts have a plastic liner on the bottom of the cart to prevent dust and splash up from mopping

  Yes

  No

  N/A

• Containers or equipment in the "ready position" is still protected by its protective coverings. (Glide Scope Blades,etc...) (IC.02.02.01)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

EMERGENCY MANAGEMENT

• Does staff know where to access emergency policies? Ask them to find two policies, one must be Code Purple

  Yes

  No

  N/A

• Staff know there role during a Plan F (Fire Response) formally Code Red. Staff know RACE and PASS

  Yes

  No

  N/A

• Staff know what their role would be during a Plan WEATHER (Severe Weather)

  Yes

  No

  N/A

• Staff know their role during a Code Purple. Ensure they know not to leave their guarded area until annAll Clear is paged overhead

  Yes

  No

  N/A

• Staff know their role during a Code Blue

  Yes

  No

  N/A

• Staff know what to do during a Code Yellow. What if they received the bomb threat

  Yes

  No

  N/A

• Staff know their role during a Code Strong. Have them describe examples when a code strong would be called

  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 more often)

  Yes

  No

  N/A

• Stored items are more than 18" from the bottom of the ceiling in any room

  Yes

  No

  N/A

• Loose papers on door shall not exceed 10% of the door's overall surface area

  Yes

  No

  N/A

• Fire extinguishers and pull stations are not blocked at all times

  Yes

  No

  N/A

• Emergency Exit signs are clearly visible and working properly (evenly illuminated)

  Yes

  No

  N/A

• Fire doors are not blocked from shutting and latching properly

  Yes

  No

  N/A

• Doors are not wedged open

  Yes

  No

  N/A

• Medical gas shut offs are properly labeled and clear of obstructions

  Yes

  No

  N/A

• Documentation is provided and logged to provide proof of the fire alarm and suppression systems. (Add info on the specific requirements, sprinklers, kitchen hood,....)

  Yes

  No

  N/A

MEDICAL EQUIPMENT MANAGEMENT

• Biomedical Inspection Labels are placed on equipment inspected from BioMed (check 5 pieces of equipment).

  Yes

  No

  N/A

• Temperatures in refrigerators are being documented according to departmental policies.

  Yes

  No

  N/A

• Equipment that emits heat has appropriate signage to reflect the hazard.

  Yes

  No

  N/A

• Blanket warmers are set within range of the warmer.

  Yes

  No

  N/A

• Fluid warmer temperatures are set to achieve a safe range.

  Yes

  No

  N/A

UTILITY SYSTEMS MANAGEMENT

• Ventilation and temperature of rooms are appropriate for the designated use.

  Yes

  No

  N/A

• Internal walls, doors, windows, ceilings, cabinetry, floors, and ect. are in good condition

  Yes

  No

  N/A

• External walls, doors, windows, ceilings, cabinetry, floors, and ect. are in good condition

  Yes

  No

  N/A

• All shut off points for utilities are labeled and properly displayed on a facility map. (This map would be located in the EVS office)

  Yes

  No

  N/A

MISCELLANEOUS

• Any other concerns during this inspection?

• Add additional photos

  Media

END OF SURVEY

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