• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. Previous Inspection

  • 1.1 Has the last EoC Inspection been reviewed?

  • 1.2 Have all outstanding concerns been resolved?

A. Life Safety Management

  • A1. Doors: Latch properly, free of doorstops, closures on storage room doors are functional?

  • A2. Are exit doors and stairwells unobstructed and clearly marked/illuminated EXIT?

  • A3. Are pull stations, fire extinguishers, electrical panels and medical gas shut-offs unobstructed?

  • A4. Are fire extinguisher monthly checks completed?

  • A5. Is material stored 18" below sprinkler heads?

  • A6. Is the area free of signs of smoking?

B. Safety Management

  • B1. Are corridors and passageways unobstructed with undamaged floors, walls, ceilings and handrails?

  • B2. Are general areas clean and clear of clutter, with furnishings, floors, walls and ceilings in good conditions?

  • B3. Are storage and equipment rooms clean and free of clutter?

  • B4. Are needle boxes less than 2/3 full?

  • B5. Are eyewash stations inspected weekly?

  • B6. Are Ceiling tiles clean, stain free, and in good condition?

C. Security Management

  • C1. Are employees wearing ID badges?

  • C2. Are medication carts locked and crash carts checklist completed, up to date?

  • C3. Are mechanical, electrical, janitorial, communication rooms and electrical panels locked?

  • C4. Is the Code One icon on PC's?

  • C5. Were all Code One Locations correct for these PCs?

  • C6. Are staff's personal belongings properly safeguarded to prevent theft?

  • C7. Are C-Doc containers properly secured to safeguard against unauthorized access to discarded PHI?

D. Infection Prevention

  • D1. Is clean linen covered and kept separate from soiled linens?

  • D2. Are patient's refrigerators clean, free of unopened & unlabeled containers and temp checks completed?

  • D3. Is medication and food kept in separate refrigerators?

  • D4. Is medical waste kept in red biohazard bags or containers?

  • D5. Are underneath sink areas clear of any storage?

  • D6. Is PPE readily available?

  • D7. Are employees eating and drinking in designated areas?

E. Utility Management

  • E1. Are electrical outlets in good condition with wires safely maintained?

  • E2. Are compressed gases stored properly, (empty separated from full) no more than 12 full E cylinders stored in one smoke area?

F. Medical Equipment Management

  • F1. Is medical equipment clean, properly inspected and tagged?

  • F2. Relocatable power tabs (RPT's) are NOT being used with medical equipment in patient care areas.

G. Hazardous Material Management

  • G1. Are Chemicals stored away from patient contact and clean items?

  • G2. Are primary and/or secondary chemical containers properly labeled?

  • G3. Staff is able to articulate how to locate a Material Safety Data Sheet on MSDSOnline.

F. Additional Identified Deficiencies

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.