Information
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Audit Title
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Conducted on
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Prepared by
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Location
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Personnel
LIFE SAFETY
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Appropriate storage of boxes and pt care items:<br> * Not directly on floor.<br> * 18" clearance from sprinkler head.<br> * Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage from mopping.<br> * Volume of combustible material is not stored in large quantity as to create a fire hazard.
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Oxygen or other combustible compressed gas cylinders are stored properly:<br> * Secured in floor stand, carrier or secured to the wall by a mount. (not laying on the floor or against wall)<br> * Limited to 12 E-cylinders per smoke compartment.<br> * Greater than 12 stored in a secured room.
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Fire exits and hallways are cleared:<br> * Egress corridors must have 8ft clearance.<br> * Equipment in corridors must be actively accessed to be in use.
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Fire alarm pull stations, fire extinguishers, medical gas shutoff valves are not blocked.
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Fire extinguishers have been inspected monthly.
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Maximum of 2-32 gallon trash cans in a 10x10 room. (unless fire rated)
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Fire doors are not blocked or propped and when closed there is positive latching.
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Exit signs are illuminated.
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Evacuation route posted & current.
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Everyone has ID badges and worn appropriately:<br> * Staff and Visitors
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Ceiling tiles are in place, no cracks, holes, misaligned or visible stains.
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Floors, ceilings, walls, and other surfaces intact and free from holes.
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Nurse call lights working.
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Are there any alarms operating appropriately?
DESCRIBE THE DEPARTMENTS RESPONSE TO ARRIVAL
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Greet the team with smiles and introductions.
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Have a space designated for the team to conduct interviews and file reviews.
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Promptly deliver materials required for review to the tracer team.
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Any additional comments regarding positive or suboptimal issues observed during the tracer.
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Surveyors Signature
