General Safety

GS 1: No broken/damaged/unused equipment or furniture stored on the patient care units? (EC.02.06.01)
Coverings are intact - no rips or repairs needed? (EC.02.06.01)

GS 2: Are all electrical appliances (coffee makers, microwaves, radios, etc.) properly wired (3 prong/UL) & appear to be in good working condition? (EC.02.01.01)

GS 3: Is the floor clean & well maintained? (EC.02.06.01)

GS 4: Hazardous rooms are locked: EVS closets, mechanical/electrical rooms & electrical panels? (EC.02.01.01)

GS 5: Linen Carts are Covered.


HAZ 1: Is appropriate hazard signage posted (pregnancy, chemical, MRI, etc.)?

HAZ 2: Are hazardous chemicals and flammable agents labeled and stored properly? (EC.02.02.01)

HAZ 3: Are gas cylinders securely mounted and stored appropriately? (EC.02.05.09)

HAZ 4: Is the HMI (Hazardous Material Inventory) current Online? (EC.02.02.01)

HAZ 5: Can the staff locate the HMI? (EC.02.02.01)

HAZ 6: Are emergency eye washes & safety showers tested and inspection logs are present? (EC.02.02.01)

HAZ 7: Are eye washes & showers easily accessed? (EC.02.02.01)

HAZ 8: Are Hazardous Materials and drugs in proper waste stream? (EC.02.02.01)

HAZ 9: Are needles, syringes, sharps & glass disposed of properly? (EC.02.02.01)

HAZ 10: Biohazard waste: (EC.02.02.01)
1. Discard in Red Bags with a biohazard symbol
2. Not overfilled
3. Covered containers
4. Contains only biohazards waste
5. Stored in a secure area

HAZ 11: Sharps Waste: (EC.02.02.01)
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.

Life Safety/Fire Management

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.02.01.35)

LS 3: Fire exits and hallways are cleared: (LS.03.01.20)
1. Egress corridors must have clearance.
2. Equipment in corridors must be in use within 30 minutes to remain in corridor.

LS 5: Have fire extinguishers been inspected monthly? (EC.02.03.05) Annually? (EC.02.03.05)

LS 6: Fire doors are not blocked, wedged or propped and when closed is positive latching? (chairs, waste containers, equipment, etc.)?(LS.02.01.10)

LS 7: Do all doors latch? (LS.02.01.10)

LS 8: Is emergency equipment (Fire Extinguishers, Fire Pull Stations, etc.) not obstructed?

LS 9: Exit signs are illuminated and readily visible/undamaged? (LS.02.01.20)

LS 10: Are all sprinkler heads clean, in good shape and escutcheons tight/in place? (LS.02.01.35)

LS 11: Ceiling tiles are in place, no cracks, holes, misaligned or visible stains? (EC.02.06.01)

LS 12: Are stairways free of storage? (LS.02.01.20 EP 14)

LS 13: Floors, ceilings, walls and other surfaces intact and free from holes, damage and soiling? (LS.02.01.30)

LS 14: Is 36" clearance maintained around electrical panels? (EC.02.06.01)

LS 15: Are electrical panels properly labeled? (EC.02.06.01)

LS 16: No daisy chain connections or extension cords?

LS 17: Are all high amps items plug directly into wall outlet? (refrigerator, microwave, etc.)

Medical Equipment

ME 1: Are bio-medical equipment stickers on patient equipment current? (EC.02.04.03) (EC.02.04.03)

ME 2: Power taps/hospital surge protectors used in patient care areas? (EC.02.05.01)


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: Is there a Bomb Threat Checklist by phones?

Utilities Management

UM 1: Are all electrical cords, plugs and switches in good order? (EC.02.01.01)

UM 2: Can the staff locate the medical zone shutoff valves? (EC.02.05.09)

UM 3: Electrical Safety (EC.02.06.01)
1. Are plugs & receptacles in good condition?
2. Wires neat and controlled with no trip hazards?


EX 1: Are manholes and vault covers secure? (EC.02.01.01)

EX 2: Are parking lots properly maintained to provide a safe driving & walking area? (EC.02.01.01)

EX 3: Are Trees, Shrubs and Plantings not intrusive? (EC.02.01.01)

EX 4: No tripping hazards noted on public walk ways?

Infection Prevention

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? No cardboard directly on floor?

IP 3: Nothing stored underneath sinks that could absorb moisture or hold water? (IC.02.02.01)

Notes and Comments

Report conclusion including any other recommendations.

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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.