Audit

Previous Inspections

Items from previous inspections have been addressed ?

Notification
Safety

Work/Storage Areas

Safety - Criteria
Notification

Other

Notification
Security

Appropriate identification used?

Criteria
Notification

Patient valuables secured ?

Criteria
Notification

Other

Notification
Hazardous Materials/Waste

Hazardous Chemicals/Waste

Criteria
Notification

BioHazardous Waste (i.e. Sharps, Patho, Solids)

Criteria
Notification

Lead Aprons

Criteria
Notification

Other

Notification
Emergency Preparedness

Emergency numbers posted (6666 on the phones) ?

Notification

Other

Notification
Fire Safety

Fire Doors

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Fire Exits

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Sprinklers

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Fire Alarm/Pull Station

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Oxygen/Gas Cylinders

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Electrical cords / strip outlets

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Fire Extinguishers

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Appliances

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Penetrations

Criteria
Field Assessment - Life Safety Interim Measures
Notification

Other

Field Assessment - Life Safety Interim Measures
Notification
Medical Equipment

Other

Notification
Physical Environment

Structural elements

Criteria
Notification

All items in storage are at least 4" off the floor

Notification

Other

Notification
Dietary / Nutrition

Patient Refrigerators: Food labeled and not expired.

Criteria
Notification

Other

Notification
Infection Prevention

Patient area free of corrugated cardboard ?

Notification

Staff eating or drinking in designated areas only ?

Notification

Hand gel/soap dispensers

Criteria
Notification

Linen covered (inside or outside of the clean utility room)?

Notification

Soiled Utility Room Secured?

Notification

Medication refrigerators temperature log (checked once for medication & twice for vaccines)

Criteria
Notification

High Level Disinfection Performed?

Notification

How do you know if equipment is ready for patient use?

Notification

Under the sink storage? (Only cleaning supplies are allowed)

Notification

Other

Notification
Utilities

Fixtures in good condition

Criteria
Notification

Facility/Utility Rooms

Criteria
Notification

Med Gas Panel

Criteria
Notification

Electrical Panels

Criteria
Notification

Return / Supply air ducts (clean/condition) ?

Notification

Appropriate pressure relationships.

Criteria
Notification

Other

Notification
Staff Knowledge

Reporting Accidents/Incidents ?

Notification

Back up/alternate communication systems ?

Notification

Code Pink ?

Notification

Code Gray ?

Notification

Hazardous Chemicals in the Area ?

Notification

Accessing SDSs ?

Notification

Code Red - RACE, PASS, Extinguisher/Fire Alarm Pull Station locations, Primary/Secondary Exits, Evacuation - horizontal/vertical ?

Notification

Oxygen Shut Off ?

Notification

Code Triage (Staff's role in a disaster - stand by and respond when/where needed) ?

Notification

Clinical Interventions for Equipment Failures ?

Notification

Utility Failure Procedures ?

Notification

How and when to use the proper PPE?

Notification
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.