Physical Environment Inspection

• Unit Name

• Director/Manager

• Conducted on

  Date

• Building

  Select Main Dunn Fondren Brown Alkek Neurosensory/ Jones Outpatient Center West Pavilion Kirby ECC Kirby Breast Center Voss ECC Pearland ECC Smith Tower Scurlock Tower

  • Main
  • Dunn
  • Fondren
  • Brown
  • Alkek
  • Neurosensory/ Jones
  • Outpatient Center
  • West Pavilion
  • Kirby ECC
  • Kirby Breast Center
  • Voss ECC
  • Pearland ECC
  • Smith Tower
  • Scurlock Tower

• Floor

  Select B1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

  • B1
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26

• Floor Section

  Select North Northeast Northwest South Southeast Southwest East West N/A

  • North
  • Northeast
  • Northwest
  • South
  • Southeast
  • Southwest
  • East
  • West
  • N/A

• Environmental Health & Safety Representative

  Select David Buchanan Arlin Cameron John Parker James Hogue Robert Jones Mike Metcalf Charles Varghese Cesar Villarreal Dawn Zapp

  • David Buchanan
  • Arlin Cameron
  • John Parker
  • James Hogue
  • Robert Jones
  • Mike Metcalf
  • Charles Varghese
  • Cesar Villarreal
  • Dawn Zapp

Fire & Life Safety

• Fire alarm pull stations & fire extinguishers accessible?

  Yes

  No

  N/A

• At least 18" clearance below sprinkler heads for combustible storage?

  Yes

  No

  N/A

• Egress is free of obstructions and corridors free of clutter?

  Yes

  No

  N/A

• Fire doors and exits signs are visible, labeled, and operable?

  Yes

  No

  N/A

• Area is free of excessive combustible materials such as paper, cardboard, trash?

  Yes

  No

  N/A

• Area free of prohibited heating items (space heaters, toasters, toaster ovens)?

  Yes

  No

  N/A

• Storage & equipment rooms neat & orderly?

  Yes

  No

  N/A

• Area free of any electrical hazards?

  Yes

  No

  N/A

Compressed Gasses

• At least 3" clearance of combustibles from compressed gas storage?

  Yes

  No

  N/A

• Compressed gas cylinders secured to prevent tipping, falling, or rolling?

  Yes

  No

  N/A

• No more than 12 full "E" oxygen cylinders per smoke zone?

  Yes

  No

  N/A

General

• Aisles, walkways, and work areas free of slip, trip, and fall hazards?

  Yes

  No

  N/A

• Emergency Procedures "Quick Reference" guide is available & current?

  Yes

  No

  N/A

• Emergency & SDS (Safety Data Sheet) decals on staff phones?

  Yes

  No

  N/A

• Are Hazardous Material containers (pharmacy, hazardous, Biohazard) appropriate?

  Yes

  No

  N/A

• Microwaves in public areas labeled with "Heating of non-food items & linen strictly prohibited"?

  Yes

  No

  N/A

• Area free of all other safety hazards during inspection?

  Yes

  No

  N/A

• Comments