Audit

1. Previous Inspection

1.1 Has the last EOC inspection been reviewed?

1.2 Have previous EOC issues been resolved?

A. Life Safety Management

A1. Doors: Latch properly, free of doorstops, closures on fire/smoke, hazardous, and storage room doors are functional?

A2. Are emergency lights, EXIT signs, EXIT doors, and stairwells unobstructed, clearly marked, and illuminating properly?

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

A4. Are fire extinguishers tagged appropriately and monthly checks completed?

A5. Is material stored at least 18" below sprinkler heads?

A6. Is the area free of any sprinkler deficiencies if required per NFPA 13, 2013 Edition, Installation of Sprinkler Systems, and NFPA 101, 2012 Edition, Life Safety Code?

A7. 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 condition?

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 with proper documentation?

B6. Are patient care areas without relocatable power strips?

C. Security Management

C1. Are employees wearing ID badges?

C2. Are medication carts locked and crash cart checklists completed and up-to-date?

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

C4. Is the "Code One" icon on the PCs?

C5. Were all "Code One" locations correct for the PCs?

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

C7. Did MRI personnel stop you at the door to Zone III, and verify that you have been screened to enter Zone III?

C7a. If you have not been screened, did they give you a copy of the screening tool to complete?

D. Infection Prevention

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

D2. Are patient's refrigerators, medication refrigerators, and specimen refrigerators clean, free of unopened and unlabeled containers, and temp checks completed with proper documentation?

D3. Is medical waste kept in red biohazard bags or containers?

D4. Are medication and food kept in separate refrigerators?

D5. Are underneath sink areas clear of any storage and clean?

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. Does the department have lead aprons? If so, do they have an appropriate and up-to-date identification tag?

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. Is the staff knowledgeable on how to identify and locate Safety Data Sheets for Hazardous Materials on the Northside Intranet?

H. Emergency Management

H1. Do written Emergency Plans exist for this site and were they reviewed (to exclude: Emergency Operations All Hazard 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 a Fire Drill been completed and documented for this location?

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

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

I. Acknowledgement: Leadership of this location is responsible to correct all items found not in compliance or marked No. Depending on the deficiency the Inspector may follow up to ensure corrections have been made. Leadership will submit a written plan of action to correct all items not in compliance to the inspector within 10 business days of the above date. If a reinspection is deemed necessary, it will be scheduled within 30-45 days of receiving the written action plan to ensure all corrections have been made. Failure to complete corrections and/or comply with the above will be reported to the Director with oversight for this location.
Signatures

We’re staff members educated and notified of deficiencies found, and notified of corrective action process?

Department/Unit Representative
Inspector
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.