Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
HOUSE KEEPING
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Items in front of outlets (Monthly)
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Items directly on floors (Monthly)
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General appearance of area. (Monthly)
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Bathrooms - clean to sight and touch, free o odors. (Monthly)
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Window, partition curtain and drapes are clean to sight and touch, free off odors. (Monthly)
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Walls, ceilings and vents are clean to sight and touch, are in good repair. (Monthly)
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Window and screens are clean o sight and touch and in good repair. (Monthly)
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Spills. (Monthly)
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Walkways/Hallways clear. (Monthly)
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Exit doors not blocked. (Monthly)
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Linens (clean/dirty) are covered and kept separately (Monthly)
ELECTRICAL/PLUMBING
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No stapled cords on surfaces (Quarterly)
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No hanging cords on nails (Quarterly)
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Exposed cords on walkways (Quarterly)
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Cords not used for permanent wiring (Quarterly)
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Sinks and faucets and re from leaks or clogs
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Outlet and switch plate covers in good repair (Quarterly)
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Check space heaters (if in use) for condition, on while unattended, proximity to combustibles material (Monthly)
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Hot water temperatures checked (110-120 degrees F) (Monthly)
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Eye wash stations are being inspected weekly (Monthly)
FURNITURE/FLOORING
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Free of spurs (Qurterly)
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Splinters (Quarterly)
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Protruding nails (Quarterly)
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Carpeting is clean, odor free and not frayed, worn, torn or buckled (Monthly)
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Tripping hazards (Quarterly)
SECURITY
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Drug cabinet locked (Montthly)
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Anesthesia area and medication secured (Monthly)
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CT contrast secured (Monthly)
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Visitors and patients are escorted through secure areas (Monthly)
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Individuals not recognized are challenged for ID (Monthly)
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Staff visibly at all times (Monthly)
FIRE/LIFE SAFETY
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Fire extinguisher inspection tags are current (Monthly)
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Exit doors are clear of obstructions
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Fire/Smoke doors properly close and latch, and are unobstructed (Monthly)
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Emergency safety features (alarm pull stations, extinguishers, oxygen zone valves are unobstructed (Monthly)
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Exit and emergency signs are operational.
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Unsafe or combustible storage stored properly (Monthly)
HIPPA CHECKLIST
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Staff discuss confidential patient information in public areas (Monthly)
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Computer monitors positioned away from public areas or casual observation (Monthly)
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Conversations with patients and/or family can be overheard (Monthly)
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Phone conversations in secure area and can not be overheard (Monthly)
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Dictation is completed where it can not be overheard (Monthly)
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Screen savers are enabled on all computers that are unattended (Monthly)
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Staff protects ID and password logons (Monthly)
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Documents with HIPPA sensitive information are secure from casual observation (Monthly)
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Paper records//medical charts are stored/filed in secured and controlled access (Monthly)
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Confidential patient information is not left on unattended printers, fax or copiers (unless in secured area) (Monthly)
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Confidential information is discarded in secure container off shredder (Monthly)
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Voice mail settings are secure (Monthly)
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Release of confidential informations is done per policy (Monthly)
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Patient list and schedules with procedures are secured (Monthly)
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Patient records are secured after hours (Monthly)
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Authorized staff have access to confidential information based on minimum necessary for task (Monthly)
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Open office doors unattended (Monthly)
HIPPA Challenge Questions
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Who is next on the schedule in the (CT sim, Gantry, IBR2, IBR3, Fixed Beam)
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Who is that (indicate a patient sitting in the waiting area or lobby)
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What is the name of our cute little pediatric patient
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What type of cancer does our pediatric patient have
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SURVEYOR - Sit an listen, what do you hear? Patient information shared over the phone or in conversation.
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SURVEYOR - What do you see? The area audited, can you see PHI on their desks or on PC screens
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SURVEYOR - Who do you see? Are the patient's badges visible? Are the visitor's badges visible?
