Information

  • 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 Are there any outstanding concerns?

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?

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

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?

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

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

  • 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?

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?

H. Emergency Management

  • H1. Do written Emergency plans exist for this site and were they reviewed (to include: Emergency Operations All Hazards Plan, Code Red Plan, Code Amber Plan, Code White Plan, Code Grey Plan, Code Orange Plan, Code Brown Plan and Emergency Transport Plan)?

  • H2. Has Fire Drill been completed and documented for this location?

  • H3. Has an Emergency Drill been completed and documented for this location?

  • H4. Has HVA been completed and documented for this location?

  • H5. Has HVA been reviewed for this calendar year?

  • Department/Unit Representative

  • Inspector

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