Nursing Home Inspection

• Department/location

• Conducted on

  Date

• Prepared by

• Add signature

  Sign

Patient Handling

• Are all staff trained in moving and handling?

  Yes

  No

  N/A

• Are appropriate lifting aids in place?

  Yes

  No

  N/A

Medications

• Medications kept secured

  Yes

  No

  N/A

Environment

• Any signs of water damage?

  Yes

  No

  N/A

• Identify any trip hazards

  Yes

  No

  N/A

• Is the lighting adequate?

  Yes

  No

  N/A

• Are there any ventilation problems in the Home?

  Yes

  No

  N/A

Clinical waste

• Is all clinical waste correctly bagged?

  Yes

  No

  N/A

Infection Control

• Are all staff trained in IC Is their training up to date?

  Yes

  No

  N/A

• Are staff provided with Personal Protective Equipment (PPE) when dealing with chemicals or biological hazards?

  Yes

  No

  N/A

• Are sharps correctly disposed of?

  Yes

  No

  N/A

Laundry

• are the interlocks on all machines working?

  Yes

  No

  N/A

• Is infected linen separated from other used linen before it is delivered to the laundry room?

  Yes

  No

  N/A

• Are all chemicals stored correctly?

  Yes

  No

  N/A

Grounds

• Are all pathways clear and accessible?

  Yes

  No

  N/A

• Is there sufficient light at night?

  Yes

  No

  N/A

Electrical safety

• Are all appliances in good condition?

  Yes

  No

  N/A

• Circuit breakers controls adequate ?

  Yes

  No

  N/A

• Any unsafe wiring noted?

  Yes

  No

  N/A

Fire safety

• Fire extinguishers deficiencies

  Yes

  No

  N/A

• Sprinkler system deficiencies

  Yes

  No

  N/A

Kitchen

• Any fire hazards noted?

  Safe

  At Risk

  N/A

• Storage

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Fire Prevention

  Safe

  At Risk

  N/A

Hazard Communication

• Containers. Properly. Labeled

  Yes

  No

  N/A

• MSDS OR SDS AVAILABLE

  Yes

  No

  N/A

Inspection report reviewed by:

• Manager

  Sign