PSL EOC Tracer Tool

3 foot clearance maintained between fire panels, med gas shut offs, fire extinguishers, and pull stations

All drinks are covered and no staff food in patient care areas

All laryngoscope blades & handles are clean and in original packaging (blades are in a peel pack or sterile tray, handles in a zip lock bag clearly marked clean, airways are individually wrapped in original packaging and sealed)

All non-patient room doors are closed and devoid of door props (look for offices supply rooms, break rooms, and so on)

All personal health information secured (face sheets, unlocked computers, patient stickers all have PHI on them)

All staff members, physicians, contractors and vendors have appropriate name tag attached above his or her waist

Ceiling tiles are in good condition with no stains or visible damage

Ceiling vents are clean and free of visible dust, dirt, or discoloration

Clean linen is kept covered no pillows on top

Crash cart (code cart) log is up to date, no blanks (Write down the date of any blanks you observe)

Doors close, latch, and are in good condition (look for dents, damage, or chipped paint)

Eye Wash Station log completed weekly for plumbed eyewash stations. For bottled eyewash stations (should be in EVS closets), the bottles are within their expiration<br>date.

Food in patient nutrition refrigerator labeled and dated with patient information and the kitchen space is clean

Furniture is in good condition with no stains, chips, or damaged fabric. Please check at least 5 pieces of furniture

Hallways, fire doors, and exits are clean and clear, all wheeled objects need to be moved out of the egress corridor. Only crash carts and/or isolation carts may be stored in corridors

O2 cylinders secured; no more than 12 cylinders stored in a smoke compartment. Full cylinders separate from not full. No plastic mesh on the cylinders.

Preventive maintenance (PM) stickers current. Please check at least 5 pieces of equipment

Supplies are within the expiration date including lab specimen tubes

Sharps Bins contain only sharps (no medication vials, band aids, other trash) Please check at least 3 bins

Temp log on refrigerators complete and actions taken when not within parameters (write on back the date and type of log of any which are non-complaint)

Testing strips (6 months) & QC solutions (3 months) for glucose monitors are dated

The unit is clear from shipping boxes and wooden pallets (boxes may be in dirty utility room, off the floor)

Unit/department is clean including drawers and cabinets. (Please look on top of high surfaces for dusting- think picture frames)

Walls are in good condition and devoid of dents or chipped paint

All suction tubing and single patient use supplies are in protective packaging<br>**Check supply/airway carts to ensure items are individually packaged as required

Ultrasound gel bottles dated with 30 day expiration date.<br>Multiuse medication bottles/vials. Once opened need a new expiration date 28 days after opening.

Make sure that PPE cabinets only have PPE items stored inside (gowns, gloves, masks, face shield masks, and safety glasses)