Nursing Area

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SAFETY

• Are call cords appropriate length and in appropriate locations?

  Yes

  No

  N/A

• No boxes stored directly on the floor in storage areas?

  Yes

  No

  N/A

• Are space heaters UL listed?

  Yes

  No

  N/A

• Are patient charts HIPAA compliant?

  Yes

  No

  N/A

• Are cables and wires neatly secured and out of the way under desks and work areas?

  Yes

  No

  N/A

• Are electrical panels unobstructed?

  Yes

  No

  N/A

• Are storage areas clean and organized?

  Yes

  No

  N/A

• Are specimens to lab properly contained and labeled?

  Yes

  No

  N/A

• Are stairwells free of stored items and no penetrations?

  Yes

  No

  N/A

• Is emergency equipment connected to red outlets?

  Yes

  No

  N/A

• Are surge protectors approved by maintenance?

  Yes

  No

  N/A

• Are floors clean and free of slip hazards?

  Yes

  No

  N/A

• Are med carts/drugs/needles secured and not accessible?

  Yes

  No

  N/A

• Are patient rooms doors and supply room doors unobstructed (doors can close and latch; doors not blocked open)?

  Yes

  No

  N/A

• Is furniture clean and in good condition?

  Yes

  No

  N/A

• Are ceiling tiles in place, not broken or moldy?

  Yes

  No

  N/A

• Are refrigerators/microwaves clean and in good working order?

  Yes

  No

  N/A

SECURITY

• Do employees know the Code Green/Pink/Green policy and their response?

  Yes

  No

  N/A

• Are employees purses secured?

  Yes

  No

  N/A

• Are employees/contract workers/volunteers/students/vendors wearing appropriate identification?

  Yes

  No

  N/A

• Patient information kept confidential?

  Yes

  No

  N/A

• Are narcotics locked?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

HAZARDOUS MATERIALS/COMMUNICATION

• Are all cleaners in the chemical inventory?

  Yes

  No

  N/A

• Are empty and full oxygen tanks stored in separate racks?

  Yes

  No

  N/A

• Are gloves used when using PDI wipes?

  Yes

  No

  N/A

• Are there SDS stickers on all the phones?

  Yes

  No

  N/A

• Are any hazardous chemicals stored properly?

  Yes

  No

  N/A

• Are oxygen tanks properly secured in racks or chained?

  Yes

  No

  N/A

• Are there less than 12 full "E" cylinders or 1"H" cylinder stored per smoke zone?

  Yes

  No

  N/A

• Are secondary containers properly labeled?

  Yes

  No

  N/A

• Are chemicals properly labelled?

  Yes

  No

  N/A

EMERGENCY MANAGEMENT

• Are flashlights available for power outages?

  Yes

  No

  N/A

• Is emergency equipment plugged into red outlets?

  Yes

  No

  N/A

• Are employees familiar with the "Code Red" Grove weather alert?

  Yes

  No

  N/A

• Is the "Systems Failures and Basic Staff Response" outline posted?

  Yes

  No

  N/A

• Do employees know where to take refuge in case of imminent weather?

  Yes

  No

  N/A

• Are employees familiar with Codes Black/White/Silver/Zero/Yellow?

  Yes

  No

  N/A

• Are emergency codes posted?

  Yes

  No

  N/A

FIRE PREVENTION

• Are hallways and exit corridors routes clear of clutter?

  Yes

  No

  N/A

• Do employees know how to use a fire extinguisher?

  Yes

  No

  N/A

• Exit signs are appropriate and illuminated?

  Yes

  No

  N/A

• Employees know where fire cards are?

  Yes

  No

  N/A

• Are storage areas free of clutter?

  Yes

  No

  N/A

• Are there NO unapproved extension cords or overloaded receptacles?

  Yes

  No

  N/A

• No storage closer than 18 inches for a sprinkler head?<br>

  Yes

  No

  N/A

• Extinguishers checked monthly?

  Yes

  No

  N/A

• Are supplies NOT stored less than 18 inches from the ceiling?

  Yes

  No

  N/A

• Are all doors having self-closures NOT blocked open?

  Yes

  No

  N/A

• Are fire extinguishers and fire pulls NOT blocked?

  Yes

  No

  N/A

EQUIPMENT

• Are there no frayed cords?

  Yes

  No

  N/A

• Is equipment safety checked?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Is equipment clean?

  Yes

  No

  N/A

• Do employees know how to remove a defective piece of equipment from service?

  Yes

  No

  N/A

• Does medical equipment have current preventative maintenance stickers?

  Yes

  No

  N/A

UTILITIES

• Yes

  No

  N/A

• Yes

  No

  N/A

• Do employees know where oxygen shutoff valves are located?<br>

  Yes

  No

  N/A

• Yes

  No

  N/A

INFECTION CONTROL

• Are standard precautions being followed?

  Yes

  No

  N/A

• Routine environmental cleaning?

  Yes

  No

  N/A

• Is PPE being worn appropriately?

  Yes

  No

  N/A

• Is PPE available?

  Yes

  No

  N/A

• Is appropriate hand hygiene being performed?

  Yes

  No

  N/A

• Are there no recapped sharps in sharps containers?

  Yes

  No

  N/A

• Sharps containers secured appropriately?

  Yes

  No

  N/A

• Sharps containers not more than 2/3 full?

  Yes

  No

  N/A

• Yes

  No

  N/A

• PPE is removed at point of use?

  Yes

  No

  N/A

• Are soap and water available?

  Yes

  No

  N/A

• Are appropriate isolation signs being used?

  Yes

  No

  N/A

• Sharps disposed of properly?

  Yes

  No

  N/A

• Waste containers not overfilled?

  Yes

  No

  N/A

• Is linen covered?

  Yes

  No

  N/A