Title Page
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Conducted on
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Prepared by
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Location
1. Personal Protective Equipment (PPE)
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PPE and disposable gloves, glasses, aprons and ear protection are available for use and in good condition
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Staff are wearing the required PPE
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Detail One item of PPE worn:
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Staff are wearing appropriate footwear I.e. non - slip rubber soled shoes
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PPE and disposable gloves, glasses, aprons are available for use and in good condition
2. Equipment / Machinery
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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.
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Cleaner’s trolleys and their wheels are in good working order
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Electrical equipment within the cleaners room is tested and tagged
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Safety signage is in place I.e. wet floor signs are being used when cleaners are mopping
3. Electrical
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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
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Detail next expiry date
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Electrical cords, extensions, plug and switches are safely arranged and in good repair I.e. Plastic covering intact
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Electrical cords are secured to prevent trip injuries
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Piggy back plugs (double adaptors) are Not used in the department
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Electrical equipment is not exposed to water
4. Housekeeping
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The environment is free of trip / slip hazards
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The floor is free from rubbish, debris and or spills
5. Emergency
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Exit doors open and close and are free from obstructions
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Staff are aware of emergency procedures and how to raise the alarm - DIAL 55
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Ask FIVE staff members 1. 2. 3. 4. 5.
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Smoke / detectors are free from damage / obstruction
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Staff have received basic fire extinguisher training
6. Storage
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Items stored on shelves are not stored too high. I.e. items on top shelves should be one box high
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Are items stored appropriately I.e. Frequently used items and heavy items stored between knee and shoulder height
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Materials are stored securely to prevent falling
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Shelves are secured to the walls / floors to prevent falling
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Safety steps are available in all storage areas
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Storage rooms are neat and tidy to allow a clear walking path and are free from rubbish
7. Chemicals
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Safety data sheet (SDS) book is stored with the chemicals in the chemical storage / cleaners room
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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
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Spill kits are available to clean up chemical spills (in bulk chemical storage areas)
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All chemicals are stored to prevent unauthorised access and storage areas are locked I.e. cleaners room is locked at the time of inspection
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No food, drinks or personal items are being stored in the cleaner’s room
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Chemical First Aid procedures and chemical information sheets are located on the wall
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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
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Cleaning staff have received chemical handling training within the last 12 months
8. Manual handling
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Staff follow correct materials manual tasks procedures
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Staff have received manual handling training within the last year
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Staff are not required to undertake tasks lifting excessive weight
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Manual handling aids are available on the ward to reduce the need for manual handling I.e. Trolley
9. Policy and Procedure
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Policy and Procedures are followed at all times and are up to date
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10. Security
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Identify badges are visible and worn at all times, including agency, doctors, students and contractors
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Designated areas are limited to authorised personnel at all times I.e. treatme
11. Waste Management
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All waste is contained and disposed of in appropriate waste stream I.e. general, clinical, confidential, recycle
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A sharps container is located in the immediate vicinity
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Total Number of Corrective Actions
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Completed by
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Department Manager Name
