Has the last audit been reviewed?

Previous nonconformities have been addressed?


Warning signs or barricades are placed when work creates a hazard (wet floor, maintenance work in ceiling)?

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

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

Area is without clutter?


Quality Control logs for Refrigerators/Freezers, freezers, and warmers are complete and corrective actions documented as appropriate?

No evidence of daisy chains?

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

Can the item be moved without difficulty in the event of an emergency?

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

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

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


Medications/medical supplies have not passed expiration dates?

All syringes, basins, cups, containing medication or solutions are labeled with the name of the contents?

Supply area is clean?

Med Carts/Med Rooms are secured at all times?

Black boxes have been emptied and are not overflowing.

Appropriate items in black boxes?

Samples are tracked per policy?

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

No items stored under the sink


Staff food is not stored in patient refrigerators?

Refrigerators/Freezers are clean, frost free, and labeled for type of storage with only those items present (no food and medication in the same refrigerator).

Refrigerators/Freezers contain thermometers and the refrigerator graphs are up-to-date? (thermometer should be located in the back)

No open or expired patient nourishment containers in refrigerator?

Ice machines are clean, no signs of deposits in tray or dispensing mechanism?

Anti-microbial soap and paper towels are available for hand washing?

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

Disposed sharps are in an approved container?

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

Staff (including contracting physicians) perform hand hygiene?

Separation of clean and dirty?


Ceiling tiles clean and intact?

Floors free of dirt, dust and litter?

Ledges, walls and air vents free of dust?

Toilets and sinks secure and clean?

Privacy curtains clean and unsoiled?


Chemicals are properly labeled and secured

Staff knows how to access Material Safety Data Sheets (MSDS)?

PPE is available?

Material Safety Data Sheet stickers are intact on phones?

Eye wash is flushed and logged?

Acids and bases stored separately?

Fume hoods have been certified?


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

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

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

Staff know where the fire extinguishers and pull stations located in your department?

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

Are the sprinkler heads free of dust?

Fire extinguisher(s) inspected on routine basis per code requirements? (monthly)

Fire extinguisher(s) green tag current?

Fire extinguishers and pull stations clear of obstructions?

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

Are med gas valves labeled?

Are full and empty cylinders stored separately according to sign/labels?

All lights are working properly and flashlights with good batteries?

Flammable and hazardous materials properly stored and labeled?

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

Exits clear of obstructions?

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

Eighteen-inch clearance from ceiling is maintained?

Confidential shred bins are compliant with NFPA Code?

Halls/Corridors uncluttered and accessible?


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

Staff know where downtime forms are located and they know how to tell if they are the most current version?


Staff know how to notify Security in a non-emergency?

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

Are valuables properly stored in department?


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

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

Equipment is clean?

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

Defibrillator is plugged in and charging?


Staff know what to do for an electrical failure?

Staff know who is authorized to shut off medical gases?

OR specific

Hyperthermia cart is locked with log completed?

Staff know location of hyperthermia cart?

Sterilizer is clean and parameters are maintained?

Sterilizer has documented PM?

Sterilizer testing is up to date?

Mechanical areas

Floor is clean?

Power tools have guards in place?

PPE readily available?

36" clearance maintained around electric panels?

Fall protection for areas above 6 feet high?

LOTO equipment readily available?

Isolation exhaust fans are labeled?


Preventive action is required?

Preventive Action Plan:

Corrective action is required?

Cause of nonconformity

Organizational corrective plan:

Person/position responsible for implementation do corrective action

Date for implementation of Plan

Determine actions needed by observing:

Results of. Actions taken:

Review effectiveness

Department/Unit Representative
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.