1. Personal Protective Equipment (PPE)

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

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

2. Equipment / Machinery

Safety steps and or step ladders are available within the area to be utilised when needed to enable access to top shelves in the cleaner’s Rooms.

Cleaner’s trolleys and their wheels are in good working order

Electrical equipment within the cleaners room is tested and tagged

Safety signage is in place I.e. wet floor signs are being used when cleaners are mopping

3. Electrical

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

Detail next expiry date

Electrical cords, extensions, plug 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. Housekeeping

The environment is free of trip / slip hazards

The floor is free from rubbish, debris and or spills

5. Emergency

Exit doors open and close and are free from obstructions

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

Staff have received basic fire extinguisher training

6. 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

Safety steps are available in all storage areas

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

7. 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. Any chemicals that have damaged labels or have no labels must be disposed of/given to WHS Department for appropriate disposal

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

All chemicals are stored to prevent unauthorised access and storage areas are locked I.e. cleaners room is locked at the time of inspection

No food, drinks or personal items are being stored in the cleaner’s room

Chemical First Aid procedures and chemical information sheets are located on the wall

No chemical residue is on the outside of the chemical containers or on the floor. All chemicals are stored appropriately and have adequate separation and bunding as required

Cleaning staff have received chemical handling training within the last 12 months

8. Manual handling

Staff follow correct materials manual tasks procedures

Staff have received 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. Trolley

9. Policy and Procedure

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

10. Security

Identify 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. treatme

11. Waste Management

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

A sharps container is located in the immediate vicinity

Total Number of Corrective Actions

Completed by
Department Manager Name
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.