• 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. Safety Management

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

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

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

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

  • A5. Are eyewash stations inspected weekly?

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

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

B. Security Management

  • B1. Are employees wearing ID badges?

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

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

  • B4. Is the Code One icon on PC's?

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

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

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

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

C. Infection Prevention

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

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

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

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

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

  • C6. Is PPE readily available?

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

D. Utility Management

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

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

E. Medical Equipment Management

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

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

F. Hazardous Material Management

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

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

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

G. Staff Knowledge Questions

  • Does Staff know their respective campus emergency number?


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

  • Unit/Floor Manager or Supervisor

  • Life Safety/EOC Inspector

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.