Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
1. PREVIOUS AUDITS
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1.1 Has the last audit been reviewed?
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1.2 Are there any outstanding concerns?
A. SAFETY/GENERAL SAFETY
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A1. Warning signs or barricades are placed when work creates a hazard?
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A2. Medication cart is locked, neat and tidy, without expired medicines/products?
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A3. Clean linen is covered with nothing on top of cart?
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A4. All furniture and equipment is in sound condition?
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A5. This area is free from sharp objects?
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A6. All wall-mounted devices are secure and not loose?
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A7. Cleaning chemicals are properly labeled and are not accessible by patients and visitors?
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A8. Logs for Refrigerators/Freezers, and warmers are complete and corrective actions documented?
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A9. Boxes of patient care item are not stored directly on the floor? (must be elevated 6")
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A10. Items are not stored under sink(s)?
B. ELECTRICAL SAFETY
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B1. Items are not stored within 30” of an electrical panel?
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B2. Electrical cords, plugs, plates and switches are in good repair?
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B3. Extension cords only used temporarily?
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B4. All areas are free of electrical “wire nests” ?
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B5. Electrical panel estate locked?
C. MEDICATION/MEDICAL SUPPLIES
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C1. Medications/medical supplies - have not passed expiration dates?
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C2. All syringes, basins, containing medication or solutions are labeled properly?
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C3. Med Carts/Med Rooms are secured at all times?
D. INFECTION PREVENTION
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D1. Staff food is not stored in patient refrigerators?
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D2. Refrigerators/Freezers are clean and labeled for type of storage?
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D3. Refrigerators/Freezers contain thermometers and the refrigerator graphs are up-to date
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D4. No open or expired patient nourishment containers in refrigerator?
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D5. Ice machines are clean, no signs of deposits?
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D6. Anti-microbial soap and paper towels are available for hand washing?
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D7. Containers used infectious waste are covered, leak proof, and clearly labeled as a biohazard?
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D8. Disposed sharps are in an approved container?
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D9. Sharps containers are secured in their holders and not overfill?
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D12. Staff (including contracting physicians) perform hand hygiene ?
E. ENVIRONMENTAL
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E1. Floors free of dirt, dust and litter?
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E2. Ledges, walls and air vents free of dust?
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E3. Toilets and sinks secure and clean?
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E4. Privacy curtains clean and unsoiled?
F. HAZARDOUS MATERIALS
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F1. ** How can you access Material Safety Data Sheets (MSDS)?
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F2. ** Do you know where your PPE is located?
G. FIRE PREVENTION/ LIFE SAFETY
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G1. ** Can you explain when you would implement R.A.C.E. and what does it stand for?
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G2. ** Can you explain P.A.S.S. and what does it stand for?
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G3. ** Where are the fire extinguishers and pull stations located?
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G4. Two exit signs visible from each corridor?
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G5. Halls/Corridors uncluttered and accessible?
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G6. Wheeled items are stored in corridor less then 30 minutes at a time?
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G7. Are ceiling tiles in place, not stained and not broken?
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G8. Are the sprinkler heads free of dust?
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G9. Fire extinguisher (s) recently serviced? (monthly)
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G10. Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)
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G11. Eighteen-inch clearance from sprinkler head ensuring no obstruction?
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G12. Are compressed gases stored in designated areas only?
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G13. Are full and empty cylinders stored separately according to sign/labels?
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G14. All lights are working properly?
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G15. Flammable and hazardous materials properly stored and labeled?
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G16. Fire extinguishers and pull stations clear of obstructions?
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G17. Placement of Hand Sanitizer is not within 6" to a potential ignition source?
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G18. Exits clear of obstructions?
H. EMERGENCY MANAGEMENT PROCEDURES
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H1. ** Can you tell me the number you would dial to initiate an emergency response?
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H2. ** Where are your Computer Downtime Forms?
I. SECURITY MANAGEMENT
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I1. ** How do you notify Security in a non-emergency?
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I2. All staff wearing ID badges @ eye level?
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I3. Are valuables properly stored in department?
J. EQUIPMENT MANAGEMENT
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J1. ** What are the procedures if a device/equipment does not work properly?
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J2. All medical equipment/devices has a current Bio-Medical sticker?
K. UTILITY MANAGEMENT
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K1. ** Where are your emergency backup procedures located for a loss of utility services?
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K2. ** In case of a fire on the unit, who is authorized to shut off medical gases?
COMMENTS/OBSERVATIONS
SIGN OFF
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Department/Unit Representative
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Auditor