Audit

Previous Inspection

Have all outstanding actions/issues been completed from the previous audit?

General Safety

GS 1: GENERAL AREA:
1. Temperature Comfortable?
2. Areas free from odors?
3. Noise levels is acceptable/adequately controlled?
4. Ventilation is adequate?
5. Stair treads and handrails present, safe & secured?

GS 2: No items stored under sinks that can absorb moisture?

GS 3: No broken/damaged/unused equipment or furniture stored on the patient care units?
Coverings are intact - no rips or repairs needed?

GS 4: Are all electrical appliances (coffee makers, microwaves, radios, etc.) properly wired (3 prong/UL) & appear to be in good working condition?

GS 5: Potential Safety Hazards:
1. Housekeeping & Maintenance carts & buckets are attended and lock?

GS 6: Is the floor clean & well maintained?

GS 7: Are non-slip surfaces adequate & in good repair?

GS 8: Is extension cord/power tap policy being enforced?

GS 9: Hazardous rooms are locked: EVS closets, supply closets, mechanical/electrical rooms & electrical panels?

GS 10: Refrigerators: Contain only those items designed for the refrigerator (specimen, medications or patient/employee food)?

GS 11: Is staff able to locate the disaster, SDS and policy manuals?
*All manuals contain current information.

GS 12: Linen and Linen Carts are Covered and carts have solid bottoms.

GS 13: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

HAZ

HAZ 1: Caution X-Ray signs are posted?

HAZ 2: Are the appropriate hazard signs posted (pregnancy, chemical, MRI, etc.)?

HAZ 3: Are hazardous chemicals and flammable agents labeled and stored properly?

HAZ 4: Are gas cylinders securely mounted and stored appropiately?

HAZ 5: Oxygen or other combustible compressed gas cylinders are stored properly:
1. Secured in floor stand, carrier or secured to the wall by a mount (not laying on the floor or against the wall).
2. Labeled and separated, full from empty.

HAZ 6: Is the HMI (Hazardous Material Inventory) current Online?

HAZ 7: Can the staff locate the HMI?

HAZ 8: Are emergency eye washes & safety showers tested and inspection tags are present?

HAZ 9: Are eye washes & showers easily accessed?

HAZ 10: Are Hazardous Materials and drugs in proper waste stream?

HAZ 11: Are needles, syringes, sharps & glass disposed of properly?

HAZ 12: 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 13: 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 14: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

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 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: Maximum of 2-32 gallon trash cans in a 10x10 room (unless fire rated)?

LS 7: Are fire doors kept closed or magnetically held open?

LS 8: Fire doors are not blocked, wedged or propped and when closed is positive latching?

LS 9: Is 20% rule being violated? No combustibles on fire rated doors and walls?

LS 10: Anything hung on the wall fire rated? Proof (certificate)?

LS 11: Exit signs are illuminated and readily visible/undamaged?

LS 12: Are all sprinkler heads clean, in good shape and escutcheons tight/in place?

LS 13: Ceiling tiles are in place, no cracks, holes, misaligned or visible stains?

LS 14: Are stairways free of storage?

LS 15: Floors, ceilings, walls and other surfaces intact and free from holes, damage and soiling?

LS 16: Laundry chute accesses are latched?

LS 17: Is 36" clearance maintained around electrical panels?

LS 18: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

Medical Equipment

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?

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.

SEC 3: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

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: 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?

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 handicapped parking available?

EX 4: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

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?

IP 3: General Cleanliness:
1. Observe surfaces for high dust & residue, floors, stairwells, nutritional area, med prep areas, lobby, exam rooms, bathrooms, equipment, decorative items, curtains, blinds or drapes.
2. No blood or bodily fluids.
3. Staff using hospital approved cleaning products according to manufacturer's recommendations.

IP 4: THERE ARE NO OTHER ABNORMALITIES OR INFRACTIONS?

Notes and Comments

Report conclusion including any other recommendations.

Certificates, license, etc.
Sign Off
Your signature or reply (email) acknowledgement when the recommended corrective actions are completed.
Auditors Signature
Select date
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.