Outpatient Ambulatory Care Rounds

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fire Safety

• The floor has updated fire plan.

  Yes

  No

  N/A

• Employees are aware of fire plan

  Yes

  No

  N/A

• NFPA diamonds are properly posted and current

  Yes

  No

  N/A

• Fire drills are performed annually and evaluated

  Yes

  No

  N/A

• Fire doors are unobstructed and door stoppers are not in use

  Yes

  No

  N/A

• Nothing comes within 18 inches of sprinkler heads

  Yes

  No

  N/A

• Fire extinguishers are unobstructed and inspected monthly

  Yes

  No

  N/A

• Pull stations are unobstructed

  Yes

  No

  N/A

• Exit signs are functioning and are in proper location

  Yes

  No

  N/A

• Smoke and fire walls have no penetrations in them

  Yes

  No

  N/A

• Evacuation and fire egress routes are unobstructed

  Yes

  No

  N/A

Chemicals and Gases

• MSDS sheets are available for all chemicals in use

  Yes

  No

  N/A

• Chemicals are all labeled without abbreviations

  Yes

  No

  N/A

• Compressed gas cylinders meet NFPA 99 standards

  Yes

  No

  N/A

• Emergency oxygen shutoff valves are unobstructed

  Yes

  No

  N/A

• Eyewash stations are inspected weekly and have proper signage

  Yes

  No

  N/A

Misc

• Needle boxes are mounted

  Yes

  No

  N/A

• Electrical cords and power strips are in good working condition

  Yes

  No

  N/A

• Calstat dispensers are not located over electrical devices or carpets.

  Yes

  No

  N/A

• Room signage is current

  Yes

  No

  N/A

• Construction projects have ILSM

  Yes

  No

  N/A

• Kitchen area is kept clean and all appliances are of commercial grade

  Yes

  No

  N/A