Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. PREVIOUS AUDITS

  • 1.1 Has the last audit been reviewed?

  • 1.2 Are there any outstanding concerns?

A. SAFETY/GENERAL SAFETY

  • A1. Warning signs or barricades are placed when work creates a hazard?

  • A2. Medication cart is locked, neat and tidy, without expired medicines/products?

  • A3. Clean linen is covered with nothing on top of cart?

  • A4. All furniture and equipment is in sound condition?

  • A5. This area is free from sharp objects?

  • A6. All wall-mounted devices are secure and not loose?

  • A7. Cleaning chemicals are properly labeled and are not accessible by patients and visitors?

  • A8. Logs for Refrigerators/Freezers, and warmers are complete and corrective actions documented?

  • A9. Boxes of patient care item are not stored directly on the floor? (must be elevated 6")

  • A10. Items are not stored under sink(s)?

B. ELECTRICAL SAFETY

  • B1. Items are not stored within 30” of an electrical panel?

  • B2. Electrical cords, plugs, plates and switches are in good repair?

  • B3. Extension cords only used temporarily?

  • B4. All areas are free of electrical “wire nests” ?

  • B5. Electrical panel estate locked?

C. MEDICATION/MEDICAL SUPPLIES

  • C1. Medications/medical supplies - have not passed expiration dates?

  • C2. All syringes, basins, containing medication or solutions are labeled properly?

  • C3. Med Carts/Med Rooms are secured at all times?

D. INFECTION PREVENTION

  • D1. Staff food is not stored in patient refrigerators?

  • D2. Refrigerators/Freezers are clean and labeled for type of storage?

  • D3. Refrigerators/Freezers contain thermometers and the refrigerator graphs are up-to date

  • D4. No open or expired patient nourishment containers in refrigerator?

  • D5. Ice machines are clean, no signs of deposits?

  • D6. Anti-microbial soap and paper towels are available for hand washing?

  • D7. Containers used infectious waste are covered, leak proof, and clearly labeled as a biohazard?

  • D8. Disposed sharps are in an approved container?

  • D9. Sharps containers are secured in their holders and not overfill?

  • D12. Staff (including contracting physicians) perform hand hygiene ?

E. ENVIRONMENTAL

  • E1. Floors free of dirt, dust and litter?

  • E2. Ledges, walls and air vents free of dust?

  • E3. Toilets and sinks secure and clean?

  • E4. Privacy curtains clean and unsoiled?

F. HAZARDOUS MATERIALS

  • F1. ** How can you access Material Safety Data Sheets (MSDS)?

  • F2. ** Do you know where your PPE is located?

G. FIRE PREVENTION/ LIFE SAFETY

  • G1. ** Can you explain when you would implement R.A.C.E. and what does it stand for?

  • G2. ** Can you explain P.A.S.S. and what does it stand for?

  • G3. ** Where are the fire extinguishers and pull stations located?

  • G4. Two exit signs visible from each corridor?

  • G5. Halls/Corridors uncluttered and accessible?

  • G6. Wheeled items are stored in corridor less then 30 minutes at a time?

  • G7. Are ceiling tiles in place, not stained and not broken?

  • G8. Are the sprinkler heads free of dust?

  • G9. Fire extinguisher (s) recently serviced? (monthly)

  • G10. Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)

  • G11. Eighteen-inch clearance from sprinkler head ensuring no obstruction?

  • G12. Are compressed gases stored in designated areas only?

  • G13. Are full and empty cylinders stored separately according to sign/labels?

  • G14. All lights are working properly?

  • G15. Flammable and hazardous materials properly stored and labeled?

  • G16. Fire extinguishers and pull stations clear of obstructions?

  • G17. Placement of Hand Sanitizer is not within 6" to a potential ignition source?

  • G18. Exits clear of obstructions?

H. EMERGENCY MANAGEMENT PROCEDURES

  • H1. ** Can you tell me the number you would dial to initiate an emergency response?

  • H2. ** Where are your Computer Downtime Forms?

I. SECURITY MANAGEMENT

  • I1. ** How do you notify Security in a non-emergency?

  • I2. All staff wearing ID badges @ eye level?

  • I3. Are valuables properly stored in department?

J. EQUIPMENT MANAGEMENT

  • J1. ** What are the procedures if a device/equipment does not work properly?

  • J2. All medical equipment/devices has a current Bio-Medical sticker?

K. UTILITY MANAGEMENT

  • K1. ** Where are your emergency backup procedures located for a loss of utility services?

  • K2. ** In case of a fire on the unit, who is authorized to shut off medical gases?

COMMENTS/OBSERVATIONS

SIGN OFF

  • Department/Unit Representative

  • Auditor

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