Northside Hospital Environment of Care Inspection - Clinical

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Previous Inspection

• 1.1 Has the last EoC Inspection been reviewed?

  Yes

  No

  N/A

• 1.2 Have all outstanding concerns been resolved?

  Yes

  No

  N/A

A. Safety Management

• A1. Are corridors and passageways unobstructed with undamaged floors, walls, ceilings and handrails?

  Yes

  No

  N/A

• A2. Are general areas clean and clear of clutter, with furnishings, floors, walls and ceilings in good conditions?

  Yes

  No

  N/A

• A3. Are storage and equipment rooms clean and free of clutter?

  Yes

  No

  N/A

• A4. Are needle boxes less than 2/3 full and safely maintained?

  Yes

  No

  N/A

• A5. Are eyewash stations inspected weekly?

  Yes

  No

  N/A

• A6. Are Ceiling tiles clean, stain free, and in good condition?

  Yes

  No

  N/A

• A7. Are patient care areas without relocatable power strips?

  Yes

  No

  N/A

B. Security Management

• B1. Are employees wearing ID badges?

  Yes

  No

  N/A

• B2. Are medication carts locked and crash carts checklist completed, up to date?

  Yes

  No

  N/A

• B3. Are mechanical, electrical, janitorial, communication rooms and electrical panels locked?

  Yes

  No

  N/A

• B4. Is the Code One icon on PC's?

  Yes

  No

  N/A

• B5. Were all Code One Locations correct for these PCs?

  Yes

  No

  N/A

• B6. Are staff's personal belongings properly safeguarded to prevent theft?

  Yes

  No

  N/A

• B7. Did MRI personnel stop you at the door to Zone III and verify that you have been screened to enter Zone III?

  Yes

  No

  N/A

• B7a. If you had not been screened did they give you a copy of the screening tool to complete?

  Yes

  No

  N/A

C. Infection Prevention

• C1. Is clean linen covered and kept separate from soiled linens?

  Yes

  No

  N/A

• C2. Are patient's refrigerators clean, free of unopened & unlabeled containers and temp checks completed?

  Yes

  No

  N/A

• C3. Is medication and food kept in separate refrigerators?

  Yes

  No

  N/A

• C4. Is medical waste kept in red biohazard bags or containers?

  Yes

  No

  N/A

• C5. Are underneath sink areas clear of any storage?

  Yes

  No

  N/A

• C6. Is PPE readily available?

  Yes

  No

  N/A

• C7. Are employees eating and drinking in designated areas?

  Yes

  No

  N/A

D. Utility Management

• D1. Are electrical outlets in good condition with wires safely maintained?

  Yes

  No

  N/A

• D2. Are compressed gases stored properly, (empty separated from full) no more than 12 full E cylinders stored in one smoke area?

  Yes

  No

  N/A

E. Medical Equipment Management

• E1. Is medical equipment clean, properly inspected and tagged?

  Yes

  No

  N/A

• E2. Does the department have lead aprons? If so do they have an appropriate and updated identification tag?

  Yes

  No

  N/A

F. Hazardous Material Management

• F1. Are Chemicals stored away from patient contact and clean items?

  Yes

  No

  N/A

• F2. Are primary and/or secondary chemical containers properly labeled?

  Yes

  No

  N/A

• F3. Is staff knowledgeable on how to identify and locate Safety Data Sheets on hazardous material on the Northside Intranet?

  Yes

  No

  N/A

G. Staff Knowledge Questions

• Does Staff know their respective campus emergency number?

  Yes

  No

  N/A

Signatures

• Were staff members educated and notified of deficiencies found and notified of corrective action process?

  Yes

  No

  N/A

• Unit/Floor Manager or Supervisor

  Sign

• Life Safety/EOC Inspector

  Sign