Information
-
Audit Title
-
Document No.
-
Client / Site
-
Conducted on
-
Prepared Department of Public Safety
-
Location
-
Personnel
-
The assessors believe the information contained within this Hazard Surveillance and Safety Inspection (Risk Assessment) report to be correct at the time of printing. The assessors do not accept responsibility for any consequences arising from the use of the information herein (attachments). The report is based on matters which were observed or came to the attention of the assessors during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made. 1-11-17 rev 3
General Safety
-
GS 1: No broken/damaged/unused equipment or furniture stored on the patient care units? (EC.02.06.01)<br> 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
-
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)<br> 1. Discard in Red Bags with a biohazard symbol<br> 2. Not overfilled<br> 3. Covered containers<br> 4. Contains only biohazards waste<br> 5. Stored in a secure area
-
HAZ 11: Sharps Waste: (EC.02.02.01)<br> 1. Placed in punctured resistant sharps container with lid.<br> 2. Disposed of when 3/4 full or "full" indicator.<br> 3. Mounted appropriately.<br> 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)<br> 1. Egress corridors must have clearance.<br> 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)
Security
-
SEC 1: Are valuables secured (purses, expensive equipment, etc.)?
-
SEC 2: Confidential Patient Information: Cannot be overhead or seen by unauthorized persons:<br> 1. Computer terminals signed off when not in use.<br> 2. Patient information is not discussed in public areas.<br> 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)<br> 1. Are plugs & receptacles in good condition?<br> 2. Wires neat and controlled with no trip hazards?
Exteriors/Grounds
-
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.
Sign Off
-
Your signature or reply (email) acknowledgement when the recommended corrective actions are completed.
-
Auditors Signature
-
Select date
