Audit

Previous Inspections

Items from previous inspections have been addressed ?

Notification

Current floor plan with fire walls and doors pulled from FM drawing database ?

Safety

Work/Storage Areas

Safety - Criteria
Notification

Other

Notification
Security

Appropriate identification used?

Criteria
Notification

Valuable items secured ?

Criteria
Notification

Other

Notification
Hazardous Materials/Waste

Hazardous Chemicals/Waste

Criteria
Notification

Lead Aprons

Criteria
Notification

Infectious Waste

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

Refrigerators (for patient refrigerators only)

Criteria
Notification

Other

Notification
Infection Prevention

Staff eating or drinking in designated areas only ?

Criteria
Notification

Hand gel/soap dispensers

Criteria
Notification

Cubicle curtains are free of visible soil ?

Criteria
Notification

Under sink storage clear (nothing allowed under sinks)?

Criteria
Notification

Dirty linen storage - room secured?

Criteria
Notification

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

Criteria
Notification

Medication refrigerators log

Criteria
Notification

High Level Disinfection - Daily and QC logs complete?

Criteria
Notification

Test Strips in a closed bottle and inside a cabinet?

Criteria
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 in the ceiling clean (not covered with dust) ?

Criteria
Notification

Appropriate pressure relationships.

Criteria
Notification

Other

Criteria
Notification
Staff Knowledge

Reporting Accidents/Incidents ?

Notification
Notification

Back up/alternate communication systems ?

Notification

Code Pink ?

Notification

Code Gray ?

Notification

Hazardous Chemicals in the Area ?

Notification

Accessing SDSs ?

Notification

Code Violet ?

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
Notification

How do you know if equipment is clean?

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.