General Safety

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.


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: PPE available?

Life Safety/Fire Management

LS 1: Is the fire alarm system functioning (look for in-terminate lights) correctly?

LS 2: Appropriate storage
1. Area does not exceed fire load with excessive combustible materials?
2. Is 18" clearance from ceiling being maintained?

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
not blocked?

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?

Medical Equipment

ME 1: Are bio-medical equipment stickers on patient equipment current?


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.

Utilities Management

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: Wires neat and controlled with no trip hazards?


EX 1: Are manholes and vault covers secure?

EX 2: Are parking lots properly maintained to provide a safe driving & walking area?

EX 3: Is parking lot/crosswalks visible?

Infection Prevention

IP 1: Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage?

Notes and Comments

Report conclusion including any other recommendations.

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Auditors Signature Rick Hacker, CHSP
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.