Oklahoma Heart Hospital EOC Audit

• Audit Title

• Document No.

• Conducted on

  Date

• Prepared by

• Personnel

1. PREVIOUS AUDITS

• Has the last audit been reviewed?

  Yes

  No

  N/A

• Are there any outstanding concerns?

  Yes

  No

  N/A

A. SAFETY/GENERAL SAFETY

• All furniture and equipment is in sound condition? (no chipped or torn surfaces- no leaky faucets)

  Yes

  No

  N/A

• All wall-mounted devices (lights, TV’s, pictures, signs, containers, handrails, etc.) are secure and not loose?

  Yes

  No

  N/A

• Area is without clutter?

  Yes

  No

  N/A

B. ELECTRICAL SAFETY

• No evidence of daisy chains?

  Yes

  No

  N/A

• Items are not stored within 36" of an electrical panel?

  Yes

  No

  N/A

• Electrical cords, plugs, plates and switches are in good repair?

  Yes

  No

  N/A

• Extension cords only used temporarily but not on a permanent everyday basis?

  Yes

  No

  N/A

• The underside of beds and counters are free of electrical “wire nests” where feet could be entangled?

  Yes

  No

  N/A

C. MEDICATION/MEDICAL SUPPLIES

• Medications/medical supplies have not passed expiration dates?

  Yes

  No

  N/A

• Supply area is clean?

  Yes

  No

  N/A

• Black boxes have been emptied and are not overflowing.

  Yes

  No

  N/A

• Appropriate items in black boxes?

  Yes

  No

  N/A

• No boxes on the floor. All supplies 6 inches off the floor?

  Yes

  No

  N/A

• No items stored under the sink

  Yes

  No

  N/A

E. ENVIRONMENTAL

• Ceiling tiles clean and intact?

  Yes

  No

  N/A

• Floors free of dirt, dust and litter?

  Yes

  No

  N/A

• Ledges, walls and air vents free of dust?

  Yes

  No

  N/A

• Toilets and sinks secure and clean?

  Yes

  No

  N/A

• Separation of clean and dirty?

  Yes

  No

  N/A

F. HAZARDOUS MATERIALS

• Chemicals are properly labeled and secured

  Yes

  No

  N/A

• Staff knows how to access Safety Data Sheets (SDS)?

  Yes

  No

  N/A

• PPE is available?

  Yes

  No

  N/A

• Safety Data Sheet stickers are intact on phones?

  Yes

  No

  N/A

• Eye wash is flushed and logged?

  Yes

  No

  N/A

• Sharps containers are secured in their holders, not accessible to residents and not more than three-fourths full?

  Yes

  No

  N/A

• Containers used for regulated or infectious waste are covered, leak proof, and clearly labeled as a biohazard?

  Yes

  No

  N/A

G. FIRE PREVENTION/ LIFE SAFETY

• Can staff explain what R.A.C.E stands for?

  Yes

  No

  N/A

• Can staff explain P.A.S.S. and what does it stand for?

  Yes

  No

  N/A

• Can staff explain what C.A.L.M. stands for?

  Yes

  No

  N/A

• Smoke detectors with 36" clearance from air supply to return?

  Yes

  No

  N/A

• Are the sprinkler heads free of dust?

  Yes

  No

  N/A

• Fire extinguisher(s) green tag current?

  Yes

  No

  N/A

• Fire extinguishers and pull stations clear of obstructions?

  Yes

  No

  N/A

• Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)

  Yes

  No

  N/A

• All lights are working properly and flashlights with good batteries?

  Yes

  No

  N/A

• Placement of Hand Sanitizer is not adjacent (within 6”) to a potential ignition source?

  Yes

  No

  N/A

• Exits clear of obstructions?

  Yes

  No

  N/A

• Eighteen-inch clearance from ceiling is maintained?

  Yes

  No

  N/A

• Confidential shred bins are compliant with NFPA Code?

  Yes

  No

  N/A

• Halls/Corridors uncluttered and accessible?

  Yes

  No

  N/A

• Are compressed gas containers stored in designated areas only and secured?

  Yes

  No

  N/A

H. EMERGENCY MANAGEMENT PROCEDURES

• Staff know the number to call to initiate an emergency response?

  Yes

  No

  N/A

I. SECURITY MANAGEMENT

• Yes

  No

  N/A

• Employees, volunteers, students, contracted staff, physicians, contractors and venders wearing ID badges @ eye level?

  Yes

  No

  N/A

• Are valuables properly stored in department?

  Yes

  No

  N/A

J. EQUIPMENT MANAGEMENT

• Staff know the procedures if a device/equipment does not work properly?

  Yes

  No

  N/A

• All medical equipment/devices has a current Bio-Medical sticker/Asset Tag?

  Yes

  No

  N/A

• Equipment is clean?

  Yes

  No

  N/A

• Crash cart is locked, logs complete, oxygen is full?

  Yes

  No

  N/A

• Defibrillator is plugged in and charging?

  Yes

  No

  N/A

• Equipment Asset numbers for biomed

K. UTILITY MANAGEMENT

• Staff know what to do for an electrical failure?

  Yes

  No

  N/A

• Staff know who is authorized to shut off medical gases?

  Yes

  No

  N/A

OR specific

• Hyperthermia cart is locked with log completed?

  Yes

  No

  N/A

• Staff know location of hyperthermia cart?

  Yes

  No

  N/A

• Sterilizer is clean and parameters are maintained?

  Yes

  No

  N/A

• Sterilizer has documented PM?

  Yes

  No

  N/A

• Sterilizer testing is up to date?

  Yes

  No

  N/A

Mechanical areas

• Floor is clean?

  Yes

  No

  N/A

• Power tools have guards in place?

  Yes

  No

  N/A

• PPE readily available?

  Yes

  No

  N/A

• 36" clearance maintained around electric panels?

  Yes

  No

  N/A

• Fall protection for areas above 6 feet high?

  Yes

  No

  N/A

• LOTO equipment readily available?

  Yes

  No

  N/A

• Isolation exhaust fans are labeled?

  Yes

  No

  N/A

Actions

• Preventive action is required?

  Yes

  No

• Preventive Action Plan:

• Corrective action is required?

  Yes

  No

• Cause of nonconformity

• Organizational corrective plan:

• Person/position responsible for implementation do corrective action

• Date for implementation of Plan

  Date

• Determine actions needed by observing:

• Results of. Actions taken:

• Review effectiveness

SIGN OFF

• Department/Unit Representative

  Sign

• Auditor

  Sign