Peterson Regional Medical Center Risk Assessment for Safety & Security

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  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<br>

  Safe

  At Risk

  N/A

• Lifting, moving, turning, patients

  Safe

  At Risk

  N/A

• Infectious agents

  Safe

  At Risk

  N/A

• Slips & falls

  Safe

  At Risk

  N/A

• Ergonomic risk

  Safe

  At Risk

  N/A

• Floor variations in threshold

  Safe

  At Risk

  N/A

• Objects in walking path

  Safe

  At Risk

  N/A

• Falls from bed

  Safe

  At Risk

  N/A

• Falls while ambulating

  Safe

  At Risk

  N/A

• Furniture condition

  Safe

  At Risk

  N/A

• Height for access

  Safe

  At Risk

  N/A

• Handrails available

  Safe

  At Risk

  N/A

• Wheelchair available

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Stairwell lights working

  Safe

  At Risk

  N/A

• Storage rooms clean and orderly

  Safe

  At Risk

  N/A

• No items are being stored under the sink

  Safe

  At Risk

  N/A

• Step ladders available to reach high places are in good shape

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Desk, chairs, furniture in safe condition

  Safe

  At Risk

  N/A

• Patient room furniture in safe condition

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

Hazardous material

• Hazardous Chemicals

  Yes

  No

  N/A

• Eye wash station inspected weekly and documented

  Safe

  At Risk

  N/A

• Medical gas cylinders are stored where full and empties are saparated

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Biohazard containers are stored properly

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Staff are able to obtain a MSDS

  Safe

  At Risk

  N/A

• Secondary container are labeled properly

  Safe

  At Risk

  N/A

• Hazardous materials properly stored

  Safe

  At Risk

  N/A

Utilities Management

• All lights are operational, no lights out

  Safe

  At Risk

  N/A

• Ceiling tiles, none discolored, wet or damaged

  Safe

  At Risk

  N/A

• HVAC System - Air temp within comfort range

  Safe

  At Risk

  N/A

• Plumbing, faucets, toilets operational ( no leaks )

  Safe

  At Risk

  N/A

• Ice machine clean and maintenance on schedule

  Safe

  At Risk

  N/A

Security Management

• Employee personal items are secured out of sight

  Safe

  At Risk

  N/A

• Employee I.D. Badges visible and worn properly

  Safe

  At Risk

  N/A

• Confidential Material secured/protected

  Safe

  At Risk

  N/A

• Equipment areas, hazardous material area rooms are secure

  Safe

  At Risk

  N/A

• Medications secured

  Safe

  At Risk

  N/A

• Doors with security hardware operate properly

  Safe

  At Risk

  N/A

• Code carts locked and in view of staff

  Yes

  No

  N/A

Fire Prevention

• Door wedged or propped open, none found

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Extinguishers is not missing damaged, or discharged

  Safe

  At Risk

  N/A

• Extinguishers has current inspection documentation

  Safe

  At Risk

  N/A

• Extinguishers clear of obstructions

  Safe

  At Risk

  N/A

• Sprinkler Heads/Smoke Detectors are clean & intact

  Safe

  At Risk

  N/A

• Fire Exit signs are illuminating and working properly

  Safe

  At Risk

  N/A

• Fire Doors close and latch properly

  Safe

  At Risk

  N/A

• Storage is less then 18" from ceiling

  Safe

  At Risk

  N/A

• Doors to Soiled/Clean/Hazardous Materials Room closed locked

  Safe

  At Risk

  N/A

• Emergency Exit Corridors/Doors are clear

  Safe

  At Risk

  N/A

• Flammables, stored appropriately

  Safe

  At Risk

  N/A

• Penetrations to Walls / Ceilings / Floors, not present

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Safety issues that came up during the Audit

  Yes

  No

  N/A

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