Title Page

  • Conducted on

  • Prepared by

  • Location

1. Office set up - ergonomics

  • An adjustable height and back rest, ergonomic chair with a five base used

  • Feet’s and lower limbs are supported by floor or footrest

  • Keyboard height allows shoulders to be relaxed

  • There is adequate working space on desk

  • Monitor approximately arm’s length from operator and eyes approximately level with top third of screen

  • Monitor screen is free from glare

  • Frequently used items are within close reach

  • Postural change occurs every 25 - 30 minutes

  • Repetitive twisting / bending of neck or back is avoided


  • The temperature is adequate / comfortable

  • Lighting and ventilation is adequate for the tasks required

  • Good vision can be obtained at entry and exit points

  • Walkways / traffic areas are clear of clutter

  • Furniture and trolleys are arranged to minimise disruption to walkways

  • Work surfaces are at an appropriate height

  • Traffic flow in area does not cause risk of collision or injury

  • Noise levels are not excessive within the department

  • There is appropriate drainage to ensure water doesn’t pool on the floor

  • Floors are even and have an appropriate slip resistance

  • Floors are free from gaps / holes / cracks

  • Stairways have adequate handrails, are clear of clutter and in good repair

  • The workplace amenities used by the staff are adequate and in a clean condition

  • Interview rooms and visiting rooms have peep holes

  • Interview room and visiting rooms have alternative exits / entry points

3. Electrical

  • Electrical appliances, cords, and equipment have been tested and tagged. Please check all items and advise when NEXT EXPIRY date is out of all of the items

  • Detail next expiry date

  • Electrical cords, extensions, plugs and switches are safely arranged and in good repair I.e. plastic covering intact

  • Electrical cords are secured to prevent trip injuries

  • Piggy back plugs (double adaptors) are NOT used in the department

  • Electrical equipment is not exposed to water

4. Personal Protective Equipment

  • PPE and disposable gloves, glasses, aprons and ear protection are available for use and in good condition

  • Staff are wearing the required PPE

  • Detail ONE item of PPE worn :

  • Staff are wearing appropriate footwear I.e. non - slip rubber soled shoes

5. Equipment / Machinery

  • Safety steps or step ladders are available to enable access to all storage areas

  • Ward trolleys, beds, commode chairs and other wheeled equipment neatly arranged wheels and brakes are adequate and in good repair, all chairs are in good repair - patients and visitor

  • Any damaged equipment has been removed from service until repair / replacement

  • All powered equipment and machinery is in good working order

  • Out of service or danger tags are available to place on faulty / damaged equipment

  • Shower chairs are inspected to ensure they are rust free and all stoppers are in place

  • Stoppers person all equipment are in place I.e. crutches , Zimmer frames etc.

  • All self help poles (monkey bars) manufactured by MEDICRAFT have been removed from service and disposed of

  • Drip / monitor stands are easy to propel and do not over balance I.e. must have a 5 point base

  • Gazunda safety check including : emergency stop, charger, emergency backup bar & horn

6. Housekeeping

  • Wet floor signs are available and used

  • Equipment not in use is removed to storage or disposed of

  • The environment is free of trip / slip hazards

  • The floor is free from rubbish, debris and or spills

  • Ward is generally clean I.e. free from dust

  • All loose items are secured in a locked storage area, all potential weapons are removed whilst not in use I.e. garden hose, sporting equipment, rocks, bricks and other potential projectiles

7. Emergency

  • Fire extinguishers and a hose reel are in close proximity, clearly marked and have been tested within the last 6 months

  • Detail when the fire extinguisher was last tested ( will be displayed on the metal tag on the neck of the extinguisher)

  • Emergency exit signs are lit and are clearly marked and visible

  • Fire and smoke doors are clearly signed

  • Exit doors open and close and are free from obstructions

  • Emergency procedures (code red - fire, code orange - evacuation, code brown - ext emergency) are contained in the fire box at the emergency assembly points and are in date

  • Emergency wall plans are in place clearly showing, exits and firefighting equipment

  • Emergency procedure flip books are located next tto o every staff telephone

  • Staff are aware of emergency procedures and how to raise the alarm - DIAL 55

  • Ask FIVE staff members 1. 2. 3. 4. 5.

  • Smoke / detectors are free from damage / obstruction

  • All emergency alarms have been tested I.e. duress alarm

  • First Aid kit is available and fully stocked

  • Staff have received basic fire extinguisher training

  • All staff keys fit locked emergency exit points and staff are aware of protocols for unlocking same exit points

8. Storage

  • Items stored on shelves are not stored too high. I.e. items on top shelves should be one box high

  • Are items stored appropriately I.e. Frequently used items and heavy items stored between knee and shoulder height

  • Materials are stored securely to prevent falling

  • Shelves are secured to the walls / floors to prevent falling

  • Storage rooms are neat and tidy to allow a clear walking path and are free from rubbish

9. Chemicals

  • Safety data sheet (SDS) book is stored with the chemicals in the chemical storage / cleaners room

  • Chemical containers are labeled with the manufacture / suppliers label

  • Spill kits are available to clean up chemical spills (in bulk chemical storage areas)

  • Appropriate PPE is worn by staff working with chemicals

  • All chemicals are stored to prevent unauthorised access and storage areas are locked I.e. cleaners room

10. Manual handling

  • Staff follow correct patient manual handling and materials manual tasks procedures

  • Staff have received patient and materials manual handling training within the last year

  • Staff are not required to undertake tasks lifting excessive weight

  • Manual handling aids are available on the ward to reduce the need for manual handling I.e. slide sheets, gazundas

11. Workplace Health and Safety Information

  • The below policies are displayed in the work area and signed by the hospital executive. * Work Health and Safety * Manual Handling. * Zero Tolerance - Aggression & Violence * Return to Work & Rehabilitation

  • Current Workplace Health and Safety Subcommittee Minutes are displayed in work area

  • Current monthly Safety reports are displayed in area

  • Injury Hotline poster displayed in work area

12. Policy and Procedure

  • Policy and Procedures are followed at all times and are up to date

  • Safe Operating Procedures (SOPs) are in place for all tasks and are up to date

13. Agency / Casual / Contractor Staff

  • All agency / casual / contractor staff have received the contractor orientation induction checklist and ward specific orientation handout

  • All agency / casual staff have signed the ward attendance register

  • All agency / casual staff are wearing appropriate ID badges

14. Security

  • Identity badges are visible and worn at all times, including agency, doctors, students and contractors

  • Designated areas are limited to authorised personnel at all times I.e. plant rooms, storage areas etc

  • A register of duress alarms is kept and duress alarms are tracked

  • A key register is kept for all service keys issued

  • home visiting protocols (E01.38) are followed and patient risk assessments are completed and remain with patient notes, for all home visiting carried out

  • There is an enforced policy limiting visitors and other bringing in items that may be used as weapons into the secure unit

  • Cutlery is counted in and out of the secure unit each meal time

  • There is a means of communication, roving phone two way radio at all times

  • The MHU is locked down at a designated time of evening, visiting hours reflect this and are enforced

  • Aggression in the department is recognised, managed and coordinated in effective manner. Access / entry to the department is controlled. Aggression management plans are in place as required and for patients with PMx of aggression

15. Waste management

  • All waste is contained and disposed of in appropriate waste stream I.e. general, clinical confidential, cytotoxic

  • Total Number of Corrective Actions

  • Completed by

  • Department Manager Name

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