Title Page

  • Date

  • Building/Address

  • Observer

Risk Management - ADA, Health, & Safety

  • Anti - Bacterial hand soap is provided at the kitchen sink for hand washing to avoid cross-contamination.

  • The kitchen and/or break area(s) are kept in generally clean conditions

  • All doors locks and deadbolts are working properly.

  • All emergency bells buzzers, and alarms are working.

  • Poison Control information and other Emergency numbers are readily available.

Risk Mangement - Fire Prevention

  • Fire Doors are not blockeed open.

  • Exits are not obstructed during normal business hours or special events.

  • Exits are propertly marked and exit signs are illuminated.

  • Excess paper, boxes, and trash are properly stored or removed (there is no fire hazard).

  • Fire extinguisher checks are current & Documented by a certified company. All gauges read normal. (View dial & Tag of ecah fire extinguisher)

  • Fire drills are conducted as required for site: <br>Offices - Annually<br>Redidences - Quarterly (one per shift)

  • Smoke detectors are tested at least once a month.

  • Fire Evaluation Route Maps are posted.

  • Montly testing of fire safety equipment documents and logs are kept onsite (Monthly FISC's satisfy this, keep onsite).

Facility Maintenance - Property Condition

  • All of the structures (buildings) and grounds are in good condition; there are no safety hazards.

  • All of the plumbing, electrical, and mechanical systems are in good working order; there are no safety hazards.

Other - Storage

  • Storage areads do not have potentially hazardous/flammable work materials.

  • No storage is within 24 inches of sprinkler heads, and no storage is within 24 inches of the ceiling where no sprinkler system exists.

Other - Stairways, Ramps, and Walking Surfaces

  • There is adequate lightning in place, including Emergency lighting.

  • Stairs and cooridors are kept clear of equipment, supplies, and other items.

  • Floors are kept dry and are not slippery.

  • Outside walkways, stairs, and parking areas are in good repair.

Other - Office Equipment

  • Paper Clutter is equipped with a wire guard between the main surfface and blade, and the blade is spring functioning and has a safety latch.<br>

  • All electrical appliances are plugged into appropriate outlets.<br>

  • All GFI outlets are tested monthly (by pushing the test button), and replaced if the test button does not work.<br>

Other - Group Homes

  • The site has a posted Evacuation / Shelter location.

  • Emergency supplies are able to be transported immediately to evacuation site.

  • Medication is kept in locked, supervised storage.

  • Medication is stored in childproof containers.

  • All sotred medication is within its expiration date.

  • All stored medication is prescribed to a current service recipient.

  • Appropirate containers are available for dispoal of medication , syringes, and medical waste.

  • Medication labels include: Client Name

  • Medication labels include: Medication Label

  • Medication labels include: Dosage

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.