Environmental Services

ES 1. Is overall cleaning satisfactory?

ES 2. Are patient care areas clean, sanitary, and free of offensive odors?

ES 3. Are non-patient care areas clean, sanitary, and free of offensive odors?

ES 4. Are air/exhaust vents free of dust build-up?

ES 5. Are patient care areas free of high level dust in the department/unit?

ES 6. Are needle disposal boxes not more than 3/4 full.

Facilities Management

FM 1. Is overall maintenance of the area satisfactory? (Fixtures, furnishings, grab bars, outlets, flooring, lighting)

FM 2. Are ceiling tiles stained, damaged, dirty or missing?

FM 3. Are the walls in good repair?

FM 4. Is emergency lighting available and functional?

FM 5. Are call light cords accessible from the floor. (Within 6 inches)

FM 6. Are ventilation, temperature, and humidity levels suitable for the care, treatment, and services provided?


SS 1. Are medication cabinets, carts, and supply closets secured when unattended? (Sharps secured)

SS 2. Are there no expired supplies in the department?

SS 3. Are heavy items stored within the optimal lifting zone? (Between shoulders and knees)

SS 4. Does the department not contain any unauthorized electrical devices? (Toaster Ovens, personal heaters, humidifiers)

SS 5. Is staff identifcation properly displayed?

SS 6. Are computers logged off and/or locked when unattended?

SS 7. Are electrical panels are not blocked (36 inches of clearance) and secured?

SS 8. PHI is secured properly? Shred boxes containing patient information secured?

SS 9. Are electrical equipment being used properly? (Extension cords, power strips, three prong adapters)

SS 10. Are security doors secured and locked?

SS 11. Is property properly secured?

Medical Equipment

ME 1. Is medical equipment labeled and have a current inspection sticker?

ME 2. Do users know if equipment is safe to use? Do users know who fixes it and how to place a work order?

ME 3. Are blanket and fluid temperatures recorded daily and within appropriate range? Are warmers overfilled?

ME 4. Are air temperature and humidity logs filled in correctly and current? (When required)

ME 5. Are Diagnostic Imaging lead aprons inspected and log completed?

ME 6. Are crash carts checked daily; defibrillator is plugged in and charging; drawers are properly sealed with tag numbers on log; full O2 cylinder?

Life Safety

LS 1. Is the spray pattern of sprinkler heads unobstructed? Are sprinkler heads undamaged, free of obstruction (dust included), estcheon plate in place?

LS 2. Are all door latches and jambs unobstructed?

LS 3. Are corridors free and clear up to 44 inches?

LS 4. Are alcohol based hand sanitizers installed properly? (Not above or within 1" beside/below an ignition source)

LS 5. Are fire doors free from coverings or decorations (exception of informational signs; laminated)?

LS 6. Are corridor walls free from items projecting more than 6" (ADA allows only 4")?

LS 7. Are fire doors and exits unobstructed?

LS 8. Are exit signs visible and illuminated as necessary?

LS 9. Is nothing stored within 18" of sprinkler heads? (Perimeter wall and stack shelving may extend up to ceiling when not directly below sprinkler or within 4" to the side.)

Emergency Management

EM 1. Do staff know location of "Red" Emergency Management/EOC book and its function?

EM 2. Do staff know emergency codes and how to respond?

EM 3. Do staff know the acronyms RACE and PASS?

EM 4. Do staff know where to find departmental requirements during a Code Pink - "Missing Person"?

EM 5. Do staff know how to contact Security for workplace violence issues? (Emergent - Duress, 66, 911/ Non-Emergent - 0, 795-3348)

EM 6. Do staff know the 3 actions to take in case of an active shooter? (Run, Hide, Fight)

EM 7. Does staff know evacuation response procedures? ("CLEAR" magnets, difference between horizontal and vertical evacuation)

Hazardous Materials

HM 1. Does the staff know how to locate SDS sheets and procedures in case the internet is unavailable?

HM 2. Are chemicals stored properly? (Flamamble lockers when over 1 gallon, cleaning closets secured)

HM 3. Are chemicals and solutions clearly marked for identification?

HM 4. Is there a biohazard label on doors and refrigerators where bio-hazards are stored?

HM 5. Are appropriate waste disposal processes are being followed? (General, Pharmaceutical)

HM 6. Is only biohazard waste in biohazard "Red" trash bins; lids closed?

HM 7. Are sharps containers closed and secured (lockable box)? No re-capped needles or garbage in box?

HM 8. Are eye wash stations available, unobstructed, and serviceable when required? (Inspections complete)

HM 9. Does staff know proper procedures for hazardous material spill or exposure? (ACCDR)

Fire Prevention

FP 1. Are fire pull stations and fire extinguishers unobstructed? Are pull stations in functional order?

FP 2. Are fire extinguishers within 75 feet of any location?

FP 3. Do fire extnguishers have current monthly and annual inspections? Are the fire extinguishers serviceable and instructions facing outward?

FP 4. Are medical gas cylinders handled and secured properly? (No bottles stored on floor, no more than 12 full O2 bottles in an area)

FP 5. Are doors not propped open with anything?

Infection Prevention

IP 1. Are staff, patient, and Bio-hazard refrigerators labeled and clean without frost build-up?

IP 2. Is clean/dirty linen stored properly? (Covered)

IP 3. Are appropriate hand hygiene products available and are staff familiar with the 5 Moments of Hand Hygiene?

IP 4. Are there no food or uncovered beverage items in patient care areas, including nursing stations?

IP 5. Supplies are stored in cabinets or on shelves and/or pallets, not on floors.

IP 6. Shelving without a solid bottom have plastic sheets under items stored. If shelving is holding bags of IV fluids they should be stored in something that will contain the liquid if there is a leak.

IP 7. External cardboard boxes are not used for storage in clinical areas.

IP 8. Are items not stored under sinks?

Other Deficiencies/Recommendations

Other Deficiencies Noted:


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.