Title Page

  • Conducted on

  • Prepared by

  • Location

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

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