GS 1: No broken/damaged/unused equipment or furniture stored on the patient care units?
Coverings are intact - no rips or repairs needed?
GS 2: Are all electrical appliances (coffee makers, microwaves, radios, etc.) properly wired (3 prong/UL) & appear to be in good working condition?
GS 3: Is the floor clean & well maintained?
GS 4: Is extension cord/power tap policy being enforced?
GS 5: Hazardous rooms are locked: EVS closets, mechanical/electrical rooms & electrical panels?
GS 6: Linen and Linen Carts are Covered and carts have solid bottoms.
GS 7: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
HAZ 1: Are the appropriate hazard signs posted (pregnancy, chemical, MRI, etc.)?
HAZ 2: Are hazardous chemicals and flammable agents labeled and stored properly?
HAZ 3: Are gas cylinders securely mounted and stored appropiately?
HAZ 4: Is the HMI (Hazardous Material Inventory) current Online?
HAZ 5: Can the staff locate the HMI?
HAZ 6: Are emergency eye washes & safety showers tested and inspection tags are present?
HAZ 7: Are eye washes & showers easily accessed?
HAZ 8: Are Hazardous Materials and drugs in proper waste stream?
HAZ 9: Are needles, syringes, sharps & glass disposed of properly?
HAZ 10: Biohazard waste:
1. Discard in Red Bags with a biohazard symbol
2. Not overfilled
3. Covered containers
4. Contains only biohazards waste, no trash
5. Stored in a secure area
HAZ 11: Sharps Waste:
1. Placed in punctured resistant sharps container with lid.
2. Disposed of when 3/4 full or "full" indicator.
3. Mounted appropriately.
4. Stored in secure location.
HAZ 12: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
LS 1: Is the fire alarm system functioning (look for in-terminate lights) correctly?
LS 2: Appropriate storage to maintained 18" clearance from ceiling?
LS 3: Fire exits and hallways are cleared:
1. Egress corridors must have 8' clearance.
2. Equipment in corridors must be in use within 30 minutes to remain in corridor.
LS 4: Fire alarm pull stations, fire extinguishers, medical gas shutoff valves and electrical panels are
LS 5: Have fire extinguishers been inspected monthly? Annually?
LS 6: Are fire doors kept closed or magnetically held open?
LS 7: Fire doors are not blocked, wedged or propped and when closed is positive latching?
LS 8: Exit signs are illuminated and readily visible/undamaged?
LS 9: Are all sprinkler heads clean, in good shape and escutcheons tight/in place?
LS 10: Ceiling tiles are in place, no cracks, holes, misaligned or visible stains?
LS 11: Are stairways free of storage?
LS 12: Floors, ceilings, walls and other surfaces intact and free from holes, damage and soiling?
LS 13: Laundry chute accesses are latched?
LS 14: Is 36" clearance maintained around electrical panels?
LS 15: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
ME 1: Are bio-medical equipment stickers on patient equipment current?
ME 2: Power taps/hospital surge protectors used in patient care areas?
ME 3: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
SEC 1: Are valuables secured (purses, expensive equipment, etc.)?
SEC 2: Confidential Patient Information: Cannot be overhead or seen by unauthorized persons:
1. Computer terminals signed off when not in use.
2. Patient information is not discussed in public areas.
3. No patient information visible to unauthorized persons.
SEC 3: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
UM 1: Are all electrical cords, plugs and switches in good order?
UM 2: Can the staff locate the medical zone shutoff valves?
UM 3: Electrical Safety
1. Use of hospital grade power strips, plugs & receptacles in good condition?
2. Wires neat and controlled with no trip hazards?
UM 4: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
EX 1: Are manholes and vault covers secure?
EX 2: Are parking lots properly maintained to provide a safe driving & walking area?
EX 3: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
IP 1: Food and drink in designated areas: no employee food of drinks in the public/patient areas, should be limited to private offices or break rooms.
IP 2: Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage?
IP 3: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?
Report conclusion including any other recommendations.