Select date

Risk factor for hazards. (0 Virtually no Risk) (1 Minimal Risk) (2 Moderate Risk) (3 High Risk) (4 Severe Risk W/ History)

Protective Measures Needed For Area (C - Change in process required) (T - Training Required) (P - Policy & Procedure Required) (E - PPE / Safety Equipment Required)

Safety Risk Assessment

Lifting heavy objects

Lifting, moving, turning, patients

Infectious agents

Slips & falls

Ergonomic risk

Floor variations in threshold

Objects in walking path

Falls from bed

Falls while ambulating

Furniture condition

Height for access

Handrails available

Wheelchair available

Storage is at least 4" from the floor. No boxes on the floor

Floors-tiles, carpet in good repair-no trip hazards

Stairwell lights working

Storage rooms clean and orderly

No items are being stored under the sink

Step ladders available to reach high places are in good shape

No electrical cords, telephone and computer wires in area that might entangle feet

Desk, chairs, furniture in safe condition

Patient room furniture in safe condition

No evidence of food, drinks or eating occurring around computers or nurse station

Hazardous material

Hazardous Chemicals

Eye wash station inspected weekly and documented

Medical gas cylinders are stored where full and empties are saparated

Medical gas cylinders restrained properly in bins, racks, or hand carts

Biohazard containers are stored properly

Sharps boxes are no more than 3/4 full; syringe disposed of properly

Staff are able to obtain a MSDS

Secondary container are labeled properly

Hazardous materials properly stored

Utilities Management

All lights are operational, no lights out

Ceiling tiles, none discolored, wet or damaged

HVAC System - Air temp within comfort range

Plumbing, faucets, toilets operational ( no leaks )

Ice machine clean and maintenance on schedule

Security Management

Employee personal items are secured out of sight

Employee I.D. Badges visible and worn properly

Confidential Material secured/protected

Equipment areas, hazardous material area rooms are secure

Medications secured

Doors with security hardware operate properly

Code carts locked and in view of staff

Fire Prevention

Door wedged or propped open, none found

Fire doors are not blocked by carts, equipment, or materials

Extinguishers is not missing damaged, or discharged

Extinguishers has current inspection documentation

Extinguishers clear of obstructions

Sprinkler Heads/Smoke Detectors are clean & intact

Fire Exit signs are illuminating and working properly

Fire Doors close and latch properly

Storage is less then 18" from ceiling

Doors to Soiled/Clean/Hazardous Materials Room closed locked

Emergency Exit Corridors/Doors are clear

Flammables, stored appropriately

Penetrations to Walls / Ceilings / Floors, not present

No unauthorized heat producing equipment present ( toasters, heaters, etc )

Safety issues that came up during the Audit

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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.