Title Page
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Site conducted
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Conducted on
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Conducted by
General Facilities
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Is the temperature and airflow in the area adequate?
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Are there any sources of excessive noise? Are noise levels at or below acceptable levels for the work being done?
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Are all light bulbs and tubes working and are all lightning covers adequately clean?
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Are the light bulbs steady and not flickering?
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Are there adequate numbers of waste and recycling receptacles and are they well positioned?
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Are light items stored in higher locations and heavier items stores in lower locations?
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Is the general conditions of walls, floors, floor coverings and ceilings good?
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Are ventilation ducts kept clean and unobstructed?
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Are areas around photocopiers and other equipment well ventilated?
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Is general indoor air quality acceptable for the majority of occupants (e.g Temperature, humidity, air flow, etc.?
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Are all the restricted areas kept locked (Medication room, pyxis Room, Linen, and Store Room) and no keys left hanging in the door
Patients Room
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Is the patients privacy kept at all times
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Is the patients room clean, tidy and free of clutter
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Patients side rails are raised all the time (when patient is on the bed- even if patient is ambulatory)
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Call bell within patients reach
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Patients bed are lowered
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Patients environment is safe- equipments are organized, no hanging wires, and floors not wet
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No food trays on top of the bin
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Toilet is clean and floor is dry
Management of Information
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No EMR left open and unattended (Patients file kept confidential)
Infection Control
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Are there sufficient hand-hygiene dispensers in your area (e.g. work area, outside and inside patient’s room, corridors etc.)?
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Are the hand-hygiene dispensers regularly filled?
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Are the staff doing the hand-hygiene practice following the 5 moments
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Are staff kept their nails cleaned and trimmed (without nail polish) as required by Infection Control
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Are medical waste bins kept clean, organized, not overloaded (no hanging gowns, face mask ties on the side of the bin)
Work stations / office furniture
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Is the area tidy and well kept?
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Are items safely stored so they are not at risk of falling off or causing injury?
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Is furniture in good repair?
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Furniture not blocking doorways?
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Are filing cabinets/desk drawers closed when not in use?
Floors, Aisles
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Floors are clean and dry (no water or any form liquid spill)
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Aisles clear and unobstructed?
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Are handrails in good condition?
Emergency Exits, Procedures and Equipment
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Are emergency numbers and procedures clearly displayed
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Are appropriate fire extinguishers visible and easy to access?
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Have fire extinguishers been inspected/tagged within the last 6 months?
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Are fire extinguishers free from obstruction?
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Are emergency exit stairs adequately lit?
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Are exit signs in place and illuminated?
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Are exit doors marked and clearly visible?
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Can exit doors be opened from inside?
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Are exit corridors clear of obstructions (including outside of the building)?
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Staff is knowledgeable about their Unit Specific Emergency Operations Procedure (EOP)
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Staff is knowledgeable about RACE and PASS?
First Aid and Crash Cart
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Are the locations of first aid kits labelled, easily visible, easily accessible, and known to staff?
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Are First Aid kits items available inside the box?
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Is the crash cart locked?
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Is Crash Cart clean?
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Is the Crash Cart external contents and defibrillator checked per shift?
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Is the Crash Cart and defibrillator machine plugged in to emergency Socket
Electrical
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Are electrical items tested, tagged and in date?
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Are all power outlets and switches in good condition (not broken) and tagged out if faulty?
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Are extension leads / power boards used as designed (Ensure no temporary or makeshift leads/power boards, double adaptors, piggyback plugs, overloading)?
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Are electrical items free from damage and unlikely to be exposed to water?
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Are electrical appliances in a safe working area?
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Are leads/cords kept clear of walkways and tucked away tidily under desks?
Manual Handling ( Please ask risk management for manual handling brochure)
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Are frequently used items within easy access between knee and shoulder?
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Are heavy items stored at waist height?
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Are step ladders or stools used to access items stored on high shelves?
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Are trolleys available and used to transport items?
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Are repetitive actions minimized and rest breaks taken?
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Is a risk assessment made when patient, furniture or offices must be moved and are the risks from manual handling? controlled as far as possible?
Ergonomics
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Is the workstation set up correctly?
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Is space under the desk clear to allow leg room and symmetrical posture to access workspace on the desk?
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Is working in an awkward or constrained posture, fixed position or standing position avoided where possible?
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Are computer monitors positioned properly (e.g to avoid glare, at the correct height, distance and angle, etc.)?
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Are equipment controls well designed and properly positioned
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Are items that are frequently used easily accessible
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Is there sufficient space for the work to be done?
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Are workstations adjustable to suit the size and height of the worker (e.g via adjustable monitor, adjustable chairs, work surface heights, etc.)?
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Have aids been provided for computer workstations (e.g foot rests, document holders, mouse bridges, etc.)?
Kitchen/pantry, food trays
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Is fridge clean and operational?
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Is microwave position at suitable height, clean and operational?
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Is oven/stove clean and operational?
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Is equipment secured?
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Is the area free from pests or evidence thereof?
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Is there adequate provision of soap, dishcloths and towels (if a sink is present)?
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Are food trays served inside the patients room and not kept outside the medical trolleys
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Are the used food trays returned to the pantry or burlodge (not kept outside the patients room on top of the medical trolley)
Toilets
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Are toilets and washing facilities kept clean and hygienic, including doors, walls and counter tops?
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Is there adequate provision of soap, hand drying facilities and toilet paper?
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Are waste bins clean, emptied regularly and well positioned?
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Are electric hand dryers maintained in good working order?
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Is lighting adequate?
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Is the floor/area free from water?
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Are Doors and their locks working?
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Female/Male signs are clear?
Hazardous Materials/Chemicals (e.g. Cleaning and Printing)
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Are flammable, explosive, toxic and asphyxiant gases stored outside?
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Are current (i.e less than 3 years old) Material Safety Data Sheets (MSDS) maintained for all substances used)?
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Are staff provided with the appropriate PPE for the hazardous substances being used?
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Are all hazardous storage cupboard and each containers labelled?
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Are chemical/biological spills kits readily accessible?
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Is all other required emergency equipment readily accessible in or very near the work area?
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Are current chemical inventories maintained for each work area?
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Are quantities of hazardous substances (e.g. flammable or combustible materials, very toxic materials, etc.) maintained at a minimum to avoid excessive storage of such items within the work area?
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Are hazardous wastes (e.g., chemical and biological agents, sharps, radioactive substances, broken glass, etc.) labelled, handled/packaged and disposed appropriately as per KFMC policy and procedure?
Personal Protective Equipment (PPE)
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Is personal protective equipment (e.g, gloves, respirators, hearing protection, safety glasses, lab coats, hard hats, etc.) provided where necessary?
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Is PPE worn where necessary?
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Is there adequate storage available for all PPE?
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Is PPE maintained in good condition?
Equipment and Machinery
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Have risk assessments been performed on all machinery?
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Is all machinery and equipment in good operating condition?
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Have all staff been properly trained in the correct operation of machinery and equipment?
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Are there inspection and maintenance tags for all machinery and equipment?
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Are hazardous and/or restricted areas clearly designated?
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Is lighting adequate for the work being performed?
Compressed Gas or Air
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Are cylinders stored in well-ventilated areas and are they properly segregated?
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Are cylinders adequately secured (e.g. individually chained, capped when not in use, etc.)?
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Are empty cylinders stored separately from full cylinders and are they adequately signed?
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Are all apparatus and line attached to cylinders appropriate for the gas and pressure present?
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Are empty and full cylinders properly transported (e.g., secured to a cylinder dolly with the cap in place)?
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Are air receivers and compressors installed with pressure gauges and relief valves?
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Are relief valves on air receivers and compressors tested regularly?
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Name and Signature
