Information

  • Name of audit and date

  • Location of Audit
  • Conducted on

  • Person Performing Audit

ALL ROOMS

  • Anesthesia cart locked.

  • Computer on wheels locked.

  • No unsupervised meds on counter, etc.

  • No non-approved cleaning /disinfecting supplies in room.

  • OR doors remain closed when not moving pts/equip/supplies

  • Computer logged off when not in use.

  • Locked cabinets within rooms are closed and locked.

  • PRNs not left in empty room.

  • No outside bags/cases or shipping containers allowed in surgery restricted areas.

  • Sterile clean supplies kept separate from dirty/soiled.

  • No stacked Kimguard.

MIDROOMS

  • No sterile items in midroom.

  • Fluids in warmer dated.

  • Area under sinks dry, empty, clean.

  • OH Med Room door remains locked.

  • Blood Refrigerator checked daily.

  • OH Pump Room med cabinet locked with no unsupervised meds.

ANESTHESIA AREA

  • Anesthesia supply room door remains closed.

  • Carts within supply room locked.

  • All equipment on one side of the hallway.

  • Equipment / supplies not blocking fire extinguishers or fired doors.

ALL AREAS

  • Equipment/Supplies not blocking electric panels or gas shut off valves.

  • Crash cart by PACU checked daily.

  • All portable carts have covers.

  • Eye wash stations (OH and Room #7) are clear of equipment and checked weekly.

  • Nothing higher than 18" from the ceiling.

  • No items stored lower than 8" from floor.

  • Eye protection and gloves worn when docking and undocking the Neptune.

  • Room 1511 no endoscope case on floor.

  • No paper binders located in sterile supplies. <br>

  • Sterile items removed from sub sterile area.

  • Room 1507 office supplies are not located with clean supplies.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.