NuPhysicia-Medical Services Audit - duplicate

GENERAL INFORMATION:

AUDITING COMPANY INFORMATION:

DOCUMENT NUMBER:
AUDITOR EMPLOYED BY:
CORPORATE ADDRESS:
CONTACT NUMBER:

AUDITOR'S INFORMATION

AUDITOR'S NAME:
AUDITOR'S POSITION/ TITLE:
EMAIL ADDRESS:
CONTACT NUMBER:

AUDITEE'S INFORMATION:

CLIENT COMPANY:
CLIENT LOGO:
CORPORATE ADDRESS:
CLIENT COMPANY REPRESENTATIVE REQUESTING AUDIT:
POSITION/ TITLE:
PROJECT/ LOCATION NAME:
LOCATION:

PURPOSE OF AUDIT:

Please list the reason(s) why the client requested this audit.
Please list the names of the persons involved in the completion of this audit.

PROJECT/ LOCATION SAFETY INDUCTION:

Did the auditor receive a project/ location safety induction PRIOR to the this audit being started?
If so, who conducted the project/ location safety induction and what was covered?

COMMENCEMENT OF AUDIT PROCESS:

What time was this audit started?

INTERVIEWS:

interviews may occur out of sequence due to personnel availability. Please see the individual beginning and ending time stamps for more specific information regarding these/ any interviews.

Initially, by choosing "YES" the auditor can activate EACH of the following options. If an option does NOT apply, the auditor does NOT need to activate it.

CLIENT MANAGEMENT PERSONNEL INTERVIEW:

CLIENT MANAGER #1 AVAILABLE:
TIME INTERVIEW BEGAN:
POSITION/ TITLE:
NAME:
PHOTOGRAPH:
COMPANY EMAIL ADDRESS:
MANAGER'S OVERALL SATISFACTION RATING WITH IDP SERVICES.
MANAGER'S OVERALL SATISFACTION RATING WITH NUPHYSICIA'S SUPPORT OF THE ASSIGNED IDP(S).
INTERVIEW COMMENTS:
ACTION ITEMS:
TIME INTERVIEW ENDED:
CLIENT MANAGER #2 AVAILABLE:
TIME INTERVIEW BEGAN:
POSITION/ TITLE:
NAME:
PHOTOGRAPH:
COMPANY EMAIL ADDRESS:
MANAGER'S OVERALL SATISFACTION RATING WITH IDP SERVICES.
MANAGER'S OVERALL SATISFACTION RATING WITH NUPHYSICIA'S SUPPORT OF THE ASSIGNED IDP(S).
INTERVIEW COMMENTS:
ACTION ITEMS:
TIME INTERVIEW ENDED:
CLIENT MANAGER #3 AVAILABLE:
TIME INTERVIEW BEGAN:
POSITION/ TITLE:
NAME:
PHOTOGRAPH:
COMPANY EMAIL ADDRESS:
MANAGER'S OVERALL SATISFACTION RATING WITH IDP SERVICES.
MANAGER'S OVERALL SATISFACTION RATING WITH NUPHYSICIA'S SUPPORT OF THE ASSIGNED IDP(S).
INTERVIEW COMMENTS:
ACTION ITEMS:
TIME INTERVIEW ENDED:
CLIENT MANAGER #4 AVAILABLE:
TIME INTERVIEW BEGAN:
POSITION/ TITLE:
NAME:
PHOTOGRAPH:
COMPANY EMAIL ADDRESS:
MANAGER'S OVERALL SATISFACTION RATING WITH IDP SERVICES.
MANAGER'S OVERALL SATISFACTION RATING WITH NUPHYSICIA'S SUPPORT OF THE ASSIGNED IDP(S).
INTERVIEW COMMENTS:
ACTION ITEMS:
TIME INTERVIEW ENDED:

IDP PERSONNEL ON DUTY-INTERVIEW:

IDP #1:
Is the appearance of the IDP appropriate and professional for this environment?
Is their hair (to include facial) kept and in accordance with client policy as it pertains to their position?
If the IDP is wearing jewelry is it being worn in accordance with client safety policy?
Has the IDP submitted an OPERATIONAL APPRAISAL?
Has the IDP received an employee performance review?
According to the IDP what are the GREATEST needs on this project:
Does the IDP have a copy of the Client's MOST current Third Party Medic JOB DESCRIPTION?
Is the IDP required to perform duties that are NOT typical for this position?
Is the IDP required to perform duties for which they are NOT adequately TRAINED?
How can the NuPhysicia Operations Team better serve the IDP(s) assigned to this project?
What type of TRAINING does the IDP feel would be MOST beneficial in meeting the need(s) of this client?
Provide a copy by photograph of the typical IDP work schedule.
Additional IDP comments:
ACTION ITEMS:
TIME INTERVIEW ENDED:
IDP #2:
Is the appearance of the IDP appropriate and professional for this environment?
Is their hair (to include facial) kept and in accordance with client policy as it pertains to their position?
If the IDP is wearing jewelry is it being worn in accordance with client safety policy?
Has the IDP submitted an OPERATIONAL APPRAISAL?
Has the IDP received an employee performance review?
According to the IDP what are the GREATEST needs on this project:
Does the IDP have a copy of the Client's MOST current Third Party Medic JOB DESCRIPTION?
Is the IDP required to perform duties that are NOT typical for this position?
Is the IDP required to perform duties for which they are NOT adequately TRAINED?
How can the NuPhysicia Operations Team better serve the IDP(s) assigned to this project?
What type of TRAINING does the IDP feel would be MOST beneficial in meeting the need(s) of this client?
Provide a copy by photograph of the typical IDP work schedule.
Additional IDP comments:
ACTION ITEMS:
TIME INTERVIEW ENDED:

ASSIGNED IDP PERSONNEL:

CURRENT OPERATIONS:

What is the extent of the current operations?

INDUSTRIAL DUTY PROVIDER INFORMATION:

Initially, by choosing "YES" the auditor can activate each of the following options. If an option does NOT apply, the auditor does NOT need to activate it.
IDP #1:
NAME:
EMAIL ADDRESS:
CREW:
SHIFT:
PHOTOGRAPH
How many years has the IDP practiced as a Pre-Hospital emergency provider at the Paramedic level?
How many years has the IDP practiced as a Remote Duty medical services provider at the Paramedic level?
IDP #2:
NAME:
EMAIL ADDRESS:
CREW:
SHIFT:
PHOTOGRAPH
How many years has the IDP practiced as a Pre-Hospital emergency provider at the Paramedic level?
How many years has the IDP practiced as a Remote Duty medical services provider at the Paramedic level?
IDP #3:
NAME:
EMAIL ADDRESS:
CREW:
SHIFT:
PHOTOGRAPH
How many years has the IDP practiced as a Pre-Hospital emergency provider at the Paramedic level?
How many years has the IDP practiced as a Remote Duty medical services provider at the Paramedic level?
IDP #4:
NAME:
EMAIL ADDRESS:
CREW:
SHIFT:
PHOTOGRAPH
How many years has the IDP practiced as a Pre-Hospital emergency provider at the Paramedic level?
How many years has the IDP practiced as a Remote Duty medical services provider at the Paramedic level?

PERSONAL PROTECTIVE EQUIPMENT:

Initially, by choosing "YES" the auditor can activate EACH of the following options. If an option does NOT apply, the auditor does NOT need to activate it.
IDP #1:
Is the IDP wearing NuPhysicia coveralls/ uniform?
Is their coveralls/ uniform in good working order?
Is their HARD HAT readily available?
Is their HARD HAT in good working order?
Are their SAFETY GLASSES readily available?
Are their SAFETY GLASSES in good working order?
Does the IDP require prescription SAFETY GLASSES?
Is HEARING protection readily available?
If so, what type?
Is the HEARING protection in good working order?
Are their STEEL TOE safety boots readily available?
Are their safety boots in good working order?
IDP #2:
Is the IDP wearing NuPhysicia coveralls/ uniform?
Is their coveralls/ uniform in good working order?
Is their HARD HAT readily available?
Is their HARD HAT in good working order?
Are their SAFETY GLASSES readily available?
Are their SAFETY GLASSES in good working order?
Does the IDP require prescription SAFETY GLASSES?
Is HEARING protection readily available?
If so, what type?
Is the HEARING protection in good working order?
Are their STEEL TOE safety boots readily available?
Are their safety boots in good working order?
ACTION ITEMS:

MEDICAL CERTIFICATION VERIFICATION:

IDP #1:
Photograph of certification:
STATE CERTIFICATION/ LICENSE:
Photograph of certification:
AHA-HCP CPR:
Photograph of certification:
AHA-ACLS:
Photograph of certification:
PRE-HOSPITAL TRAUMA CERTIFICATION:
Photograph of certification:
Photograph of certification:
Photograph of certification:
Photograph of certification:
Photograph of certification:
IDP #2:
Photograph of certification:
STATE CERTIFICATION/ LICENSE:
Photograph of certification:
AHA-HCP CPR:
Photograph of certification:
AHA-ACLS:
Photograph of certification:
PRE-HOSPITAL TRAUMA CERTIFICATION:
Photograph of certification:
Photograph of certification:
Photograph of certification:
Photograph of certification:
Photograph of certification:
ACTION ITEMS:

OFFSHORE/ INDUSTRIAL CERTIFICATION VERIFICATION:

OGUK PHYSICAL:
Photograph of certification:
USCG PHYSICAL:
Photograph of certification:
CAPP PHYSICAL:
Photograph of certification:
DOT PHYSICAL:
Photograph of certification:
TWIC CARD:
Photograph of certification:
HELICOPTER UNDERWATER EGRESS TRAINING (HUET):
Photograph of certification:
OPITO APPROVED BOSIET:
Photograph of certification:
WELL CONTROL:
Photograph of certification:
IADC RigPass:
Photograph of certification:
SafeGulf:
Photograph of certification:
SafeLand:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
OGUK PHYSICAL:
Photograph of certification:
USCG PHYSICAL:
Photograph of certification:
CAPP PHYSICAL:
Photograph of certification:
DOT PHYSICAL:
Photograph of certification:
TWIC CARD:
Photograph of certification:
HELICOPTER UNDERWATER EGRESS TRAINING (HUET):
Photograph of certification:
OPITO APPROVED BOSIET:
Photograph of certification:
WELL CONTROL:
Photograph of certification:
IADC RigPass:
Photograph of certification:
SafeGulf:
Photograph of certification:
SafeLand:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
OTHER CERTIFICATION:
Photograph of certification:
ACTION ITEMS:

ON-SITE MEDICAL RELATED TRAINING:

ACTION ITEMS:

HOSPITAL RELATED:

Is the hospital identified by the appropriate signs from all access/ egress pionts?
What is the location of the secondary hospital if the PRIMARY cannot be accessed?
Is the hospital clean and kept in a manner appropriate for receiving patients?
Is the hospital used for general/ over flow storage?
What is the total patient capacity for this hospital? Keep in mind the requirement is 1 bed dedicated for every 30 POB and these beds do not necessarily have to be in the hospital. If the extra beds are at alternative locations, then identify these locations below.
Is there enough room around the patient examination area that a team could work a code or critical event?
Does the IDP sleep/ live in the hospital while on the project? If not, where does the IDP board and how close is their quarters to the hospital.
How often is the hospital completely disinfected?
Is the system for BIOHAZARD containment in the hospital adequate for the current volume of waste being produced? Who manages this system (NuPhysicia or the Client)?
Photograph the EXAMINATION area.
Photograph the BERTHING area.
Photograph the OFFICE area.

PATIENT EXAMINATION AREA:

Is there a dedicated patient examination space?
Can privacy be provided for in the event of a sensitive examination?
Is it possible to over hear an on-going patient examination if more than one person is in the hospital?
If so, how is this situation addressed?
Photograph the PATIENT EXAMINATION area?

OFFICE WORK SPACE:

is there adequate WORK/ DESK space in the office area?
What forms of communication (Gaitronics, telephone, radio, emergency bell, etc.) are available in the hospital?
Is there a dedicated computer for use by the medic in the hospital office space?
Are their sufficient OUTLETS available in the WORK/ DESK area?
Photograph of electrical outlets:
What standard of ELECTRICITY is being used (220/ 110 UK, USA, etc.)?
Is there an EXTERNAL hard drive for BACK-UP of files available?
Photograph WORK/ DESK area?
ACTION ITEMS:

MEDICAL EQUIPMENT RELATED:

FIXED/ MOUNTED MEDICAL OXYGEN TANKS(S) & STORAGE:

How many and what type of LARGE oxygen tanks are on this project?
HOW are they secured and WHERE are they maintained?
Are they appropriate/ compatible for filling for the CURRENT region?
When were they LAST hydro tested?
When is the NEXT hydro testing required?
Photograph LARGE oxygen cylinder.

PORTABLE MEDICAL OXYGEN TANK(S) & STORAGE:

How many and what type of PORTABLE oxygen tanks are on this project?
HOW are they secured and WHERE are they maintained?
Are they appropriate/ compatible for filling for the CURRENT region?
When were they LAST hydro tested?
When is the NEXT hydro testing required?
Photograph PORTABLE oxygen cylinder.

TELEMEDICINE EQUIPMENT:

Is this equipment in good working order?
When was the LAST time this equipment was serviced/ upgraded?
Is this equipment being used from the original case as it was provided by nuPhysicia?
Does this equipment have an external MONITOR set-up?
Does this equipment have immediate access to an electrical outlet?
Was a communications check with studio 3 performed during the audit?
Are the JED MED scopes in good working order?
Does this project have any connectivity/ band width issues that regularly affect the use of the telemedicine equipment?
What is the CURRENT band width setting for this equipment:
Photograph the location this equipment is being used from.
Photograph the MOST current communications check log.

AUTOMATED EXTERNAL DEFIBRILLATORS (AED):

Is the IDP responsible for the inspection the AED's?
When was this equipment LAST serviced?
How many AED's are on this project and where can they be found?
Is everyone onboard trained on how to use the AED's and where they are located?
Photograph the equipment:
Photograph LAST inspection.

CARDIAC. MONITOR/ DEFIBRILLATOR:

Is there a ZOLL M-Series (NIBP, CO2, Pulse Ox, Pacing, Handsfree Defibrillator/ Cardiac Monitor) as provided by NuPhysicia?
When was this equipment LAST serviced?
Is this monitor in good working order?
Are ALL of the associated supplies/ cables available for this monitor?
Is the DEFIBRILLATION test pack available for this monitor?
Photograph this equipment:
Photograph LAST inspection.
If NOT, is there a CLIENT/ SECONDARY Cardiac Monitor available?
When was this equipment LAST serviced?
If so, provide type and specifications.
Is this monitor in good working order?
Are ALL of the associated supplies/ cables available for this monitor?
Is the DEFIBRILLATION test pack available for this monitor?
Photograph this equipment:
Photograph LAST inspection.

CRASH CART:

Does the clinic have an adequate CRASH CART?
Does the Crash Cart have adequate storage for ALL standard emergency supplies and medication?
Does the CRASH CART lock?
Photograph CRASH CART.

GLUCOMETER:

Is the GLUCOMETER in good working order?
What is the DATE of the current calibration solution?
Photograph this equipment:
Photograph LAST inspection.

CHOLESTECH:

Does this project have a CHOLESTECH?
When was this equipment LAST serviced?
Photograph this equipment:
Photograph LAST inspection.

HEMACUE:

Does this project have a HEMOCUE?
When was this equipment LAST serviced?
Photograph this equipment:
Photograph LAST inspection.

AUTOCLAVE:

Does this project have a AUTOCLAVE?
Does the IDP have to maintain this AUTOCLAVE or can it be stored for future use?
When was this AUTOCLAVE last serviced and tested for FUNGI?
Photograph this equipment:
Photograph LAST inspection.

EYE WASH STATIONS:

Is the IDP responsible for regular inspection of the EYE WASH stations?
How many EYE WASH stations does this project have and where are they located?
Photograph this equipment:
Photograph LAST inspection.

RESCUE EQUIPMENT:

What type of RESCUE equipment is stored in the hospital?
Is RESCUE equipment stored anywhere else on the project? If so, what kind?
Photograph this equipment:
Photograph LAST inspection.
ACTION ITEMS:

STORAGE & SUPPLY/ INVENTORY RELATED:

INVENTORY/ SUPPLIES & ORDERING:

Has the inventory been completed regularly on this project?
What was the LAST date of completion?
Has this project consistently completed USAGE reports & SUPPLY requisitions as expected and in a timely manner?
What is the typical TURN-AROUND time for supply orders?
IDP COMMENTS REGARDING INVENTORY/ SUPPLIES & ORDERING:

REFRIGERATOR:

Does the hospital have a refrigerator designated for medical use?
Does this refrigerator have a dedicated locking mechanism?
Does this refrigerator have an EXTERNALLY visible temperature monitor?
What is CURRENTLY being kept in this refrigerator?
Photograph the INTERIOR of the refrigerator.
Photograph the EXTERIOR of the refrigerator.
Photograph MOST current refrigerator temperature log.

MEDICAL SUPPLY STORAGE CABINETS:

Where are MEDICAL SUPPLIES stored?
Do the MEDICAL supply cabinets have adequate storage?
Do the MEDICAL supply cabinets LOCK?
Photograph the MEDICAL SUPPLIES storage location.

RANDOM MEDICAL SUPPLY COUNT:

Go to the MOST recently completed inventory and CHOOSE up to 10 different medical supply items.

Establish the approved forms & concentration and then have the IDP present them for counting.
MEDICAL SUPPLY ITEM 1: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 2: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 3: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 4: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 5: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 6: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 7: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 8: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 9: Name, PAR Level and Quantity On Hand.
MEDICAL SUPPLY ITEM 10: Name, PAR Level and Quantity On Hand.

MEDICATION STORAGE CABINETS:

Do the MEDICATION cabinets have adequate storage?
Do the MEDICATION cabinets LOCK?

OVER THE COUNTER MEDICATION STORAGE:

Where are the OTC medications stored?
Are they adequately secured?
Photograph the OTC medication storage location.

RANDOM OTC MEDICATION COUNT:

Go to the MOST recently completed inventory and CHOOSE up to 5 different medications.

Establish the approved preparation, concentration and PAR. Then have the IDP present them for counting.
OTC MEDICATION 1: Name, PAR Level and Quantity On Hand.
OTC MEDICATION 2: Name, PAR Level and Quantity On Hand.
OTC MEDICATION 3: Name, PAR Level and Quantity On Hand.
OTC MEDICATION 4: Name, PAR Level and Quantity On Hand.
OTC MEDICATION 5: Name, PAR Level and Quantity On Hand.

PRESCRIPTION MEDICATION STORAGE:

Where are PRESCRIPTION medications stored?
Are they adequately secured?
Add media

RANDOM PRESCRIPTION MEDICATION COUNT:

Go to the MOST recently completed inventory and CHOOSE up to 5 different medications.

Establish the approved preparation, concentration and PAR. Then have the IDP present them for counting.
PRESCRIPTION MEDICATION 1: Name, PAR Level and Quantity On Hand.
PRESCRIPTION MEDICATION 2: Name, PAR Level and Quantity On Hand.
PRESCRIPTION MEDICATION 3: Name, PAR Level and Quantity On Hand.
PRESCRIPTION MEDICATION 4: Name, PAR Level and Quantity On Hand.
PRESCRIPTION MEDICATION 5: Name, PAR Level and Quantity On Hand.

CONTROLLED SUBSTANCES:

Where are the CONTROLLED SUBSTANCES stored?
Does the IDP know the CONTROLLED SUBSTANCE disposal policy?
What substances are being maintained?
Are ALL of these substances on the NuPhysicia FORMULARY?
Who has ACCESS to this location?
What is the procedure for counting/ controlling these medications?
When were the CONTROLLED SUBSTANCES last used/ inspected and who was involved?
Photograph CONTROLLED SUBSTANCE safe/ location.
Photograph MOST current CONTROLLED SUBSTANCE LOG.

GO/ JUMP BAGS:

Does this project have an IRON DUCK Go Bag as provided by NuPhysicia?
Are the ZIPPERS sealed/ tagged to prevent tampering?
Photograph:
Photograph LAST inspection:
If NOT, is there a CLIENT/ SECONDARY Go Bag available?
Are the ZIPPERS sealed/ tagged to prevent tampering?
Photograph:
Photograph LAST inspection:

FIRST AID KITS:

Is the IDP responsible for regularly inspecting the FIRST AID kits?
How many FIRST AID kits does this project have and where are they located?
Photograph:
Photograph LAST inspection:
ACTION ITEMS:

HYGIENE & OCCUPATIONAL MEDICINE:

HYGIENE-GALLEY:

What is the name of the Catering vendor assigned to this project?
How long have they operated from this project?
What is the percentage of satisfaction representing how the services of the Catering vendor are received by those using their services?
When was the last Galley Hygiene inspection conducted?
Who conducted the Galley Hygiene inspection?
What was the outcome of the last Galley Hygiene inspection?
Galley Photos:

HYGIENE-LIVING QUARTERS:

How often are the living quarters cleaned?
How often are the living quarters disinfected?
What is the process for disinfection?

OCCUPATIONAL MEDICINE:

Does this project participate in a seasonal Influenza vaccination program?
Does this project participate in a prophylactic Hepatitis B vaccination program?
List any other vaccinations maintained on site.
Does this project participate in work site physicals?

MEDICAL EMERGENCY RESPONSE PLAN:

Is the CURRENT project/ location MERP posted in the hospital
How long has the project been on this location?
Who provided this MERP?
Has ALL of the communication information for the current location been confirmed?
How many points of ACCESS/ EGRESS does the hospital have and what are their locations?
What forms of communication are accessible while in the hospital?
Has a MERP drill been conducted from this location?
What was the date of the last MERP Drill? This drill is to be conducted as a monthly table top, a quarterly scenario requiring physician consult or an annual full response scenario.
What is the date of the last time the MERP was updated?
Who was the person responsible for the update?
When is the MERP scheduled to be updated/ revised?
Photograph of the cover page of the MOST current MERP.

PATIENT TRANSPORT:

Does this project location have any TASK BASED RISK ASSESSMENT (TBRA)/ JOB SAFETY ANALYSIS (JSA) for PATIENT TRANSFER to the hospital/ heliport from ANY/ ALL High Risk areas of the project/ location?
In the event of a patient EVACUATION from a high risk location is their a medically configured aircraft contracted for coverage?
What type of aircraft is assigned and what is the capacity and range?
Is the IDP expected to depart with the patient on this aircraft?
What is the name of the company?
What is the estimated response time to this location during the DAY?
If this aircraft is rated to fly at NIGHT, what is the estimated response time to this location?
If a medically configured aircraft is NOT available, is their a crew transport aircraft capable of responding in this manner?
What type of aircraft do they use and what is the capacity and range?
Is the IDP expected to depart with the patient on this aircraft?
What is the name of the company?
What is the estimated response time to this location during the DAY?
If this aircraft is rated to fly at NIGHT, what is the estimated response time to this location?
Does this project have a SECONDARY emergency response kit (Go/ Jump bag) prepared for flying in with patients (pillow, blankets, etc)?
ACTION ITEMS:

DOCUMENTATION RELATED:

Is the PROJECT REFERENCE DOCUMENT on the InPlace University Website current? If NOT, why is this document not being utilized?
When was the LAST time this document was updated?
Are handover notes being generated and used to cover ALL operational information to be referenced by opposite personnel? If so what format is currently being used?
When was the LAST time handover notes were generated and by whom?
Does the IDP maintain the daily medical dispensing/ first aid log?
Are the medical records secured (locked) properly?
Does the IDP provide regularly scheduled general health training?
When was the LAST training that was held and what were the topics?
Provide copy by photograph:
Does the IDP provide regularly scheduled RESCUE/ FIRST AID TEAM training?
When was the LAST training that was held and what were the topics?
Provide copy by photograph:
Does the IDP conduct regular WATER testing?
When was the LAST test conducted and what were the results?
Provide copy by photograph:
Does the IDP conduct regular GALLEY/ HYGIENE inspections?
When was the LAST inspection conducted and what were the results?
Provide copy by photograph:
ACTION ITEMS:

ADMINISTRATIVE:

ACCESS & ACCOUNTS:

EMRLite:
INPLACE UNIVERSITY:
EMS MANAGER:
SALESPOINT INVENTORY SYSTEM::
Does the IDP know how to submit an IT help ticket? Do they know who to call for technical issues with the B3?

REFERENCE MATERIALS:

PHYSICAL COPY-CURRENT MSDS Sheets for ALL Medication or Medical Substances being used onboard?
PHYSICAL COPY-CURRENT MSDS Sheets for ALL Substances being used onboard?
PHYSICAL COPY-CURRENT eCareGroup MEDICAL PROTOCOLS:
E COPY-CURRENT eCareGroup MEDICAL PROTOCOLS:
E COPY-CURRENT MERCK MANUAL:
PHYSICAL COPY-CURRENT WHO-INTERNATIONAL MEDICAL GUIDE FOR SHIPS:
PHYSICAL COPY-CURRENT ACLS ALGORITHMS & POSTED:
PHYSICAL COPY-CURRENT ALS FIELD GUIDE:
PHYSICAL COPY-PARAMEDIC TEXT BOOK:
E COPY-PHYSICIAN's DESK REFERENCE:
PHYSICAL COPY-CURRENT MEDIC FIRST AID-INSTRUCTOR MATERIALS:
PHYSICAL COPY-MEDIC FIRST AID-STUDENT MATERIALS:
OTHER REFERENCE:
Photograph other reference:
OTHER REFERENCE:
Photograph other reference:
OTHER REFERENCE:
Photograph other reference:
ACTION ITEMS:

SAFETY PROGRAM MANAGEMENT:

What is the current project safety record?
Outside of personally working safe, what is the IDP's safety related responsibilities for this project?
Per the IDP interviewed, is there a conflict between time allocated for medical and safety responsibilities?
Are there any suggestions for improvement of this process?
ACTION ITEMS:

QUALITY OF LIFE:

What is the overall quality of life as provided for on this project?
What are the routine off-duty activities most enjoyed?
What ammentities are available for off-duty entertainment?
Is the protection from ambient noise levels adequate so that sleep is not easily disturbed?
ACTION ITEMS:

WELLNESS PROGRAM:

Have all the IDP's assigned to this project been trained to administer the Wellness program? If not, then list the names of the IDP's who still require training.
What percentage of completion is the status of the first round HRA's?
ACTION ITEMS:

AUDIT COMPLETION & SUMMARY:

TIME AUDIT COMPLETED:
AUDITOR SIGNATURE:
IDP #1 SIGNATURE:
IDP #2 SIGNATURE:
SUMMARY NOTES: