Audit

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

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?

Security

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?

Exteriors/Grounds

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.

Sign Off
Your signature or reply (email) acknowledgement when the recommended corrective actions are completed.
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.