1.1 Has the last audit been reviewed?

1.2 Are there any outstanding concerns?


A1. Work Surface Clean

A2. Code cart is locked, neat and tidy/

A3. Emergency cart/drug box/defibrillator checks are current.

A4. All furniture and equipment is in sound condition? (no chipped or torn surfaces- no leaky faucets)

A5. Refrigerator/freezer temperature checks are current?

A6. Expiration dates checked (meds, food, supplies)?

A7. Cleaning chemicals are properly labeled and are not accessible by residents and visitors?

A8. Personal Protection equipment available (all Rooms)

A9. Boxes of patient care items/supplies are not stored directly on the floor or bottom shelves have protective covers?

A10. Items are not stored under sink(s)? (If items found - list in comment section.)

A11. Storage of oxygen Cylinders (chained to wall or secured in Carrier)?

A12. Are oxygen cylinders properly segregated and in proper storage?

A13. Are Syringes/needles in secured areas?

A14. Eye wash station available and unobstructed?

A15. Ceiling tile not stained or dirty


B1. Items are not stored within 36” of an electrical panel?

B2. Electrical cords, plugs, plates and switches are in good repair?

B3. Extension cords only used temporarily but not on a permanent everyday basis?

B4. The underside of beds and counters are free of electrical “wire nests” where feet could be entangled?

B5. Are multiplug strips secured off floor?

B6. Are Electrical Panels locked?

B7. Does each electrical panel have proper legend?


D1. Staff food is not stored in patient refrigerators?

D2. Refrigerators/Freezers are clean, frost free, and labeled for type of storage with only those items present (no food and medication in the same refrigerator).

D3. No open or expired patient nourishment containers in refrigerator?

D4. Ice machines are clean, no signs of deposits in tray or dispensing mechanism?

D5. Anti-microbial soap and paper towels are available for hand washing?

D6. Containers used for regulated or infectious waste are covered, leak proof, and clearly labeled as a biohazard?

D7. Disposed sharps are in an approved container?

D8. Sharps containers are secured in their holders, not accessible to residents and not more than three-fourths full?


E1. Floors free of dirt, dust and litter?

E2. Ledges, walls and air vents free of dust?

E3. Toilets and sinks secure?

E4. Privacy curtains clean and unsoiled?


F1. ** How can you access Material Safety Data Sheets (MSDS)?

F2. ** Do you know where your PPE is located?

F3. Handwashing facilities readilyaccessible and not expired?

F4. Sharps containers are in proper location and secure?

F5. Sharps containers contain appropriate material (ie. no gloves, gauze and tubing.)

F6. Items in BioHazardous Waste box is appropriate?


G1. ** Can you explain when you would implement R.A.C.E. and what does it stand for?

G2. ** Can you explain P.A.S.S. and what does it stand for?

G3. ** Where are the fire extinguishers and pull stations located in your department?

G4. Two exit signs visible from each corridor with appropriate arrow direction?

G5. Halls/Corridors uncluttered and accessible?

G6. Are Medical Gas cut off valves labeled and reference correct cut off areas?

G7. Are ceiling tiles in place.

G8. Are the sprinkler heads free of dust?

G9. Fire extinguisher (s) recently serviced? (monthly)

G10. Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)

G11. Eighteen-inch clearance from sprinkler head ensuring no obstruction?

G12. Are compressed gases stored in designated areas only and less than 12 cylinders per smoke compartment?

G14. All lights are working properly?

G15. Flammable and hazardous materials properly stored and labeled?

G16. Fire extinguishers and pull stations clear of obstructions?

G17. Placement of Hand Sanitizer is not adjacent(with-in 1”) to a potential ignition source?

G18. Exits clear of obstructions?

G19. Are Medical gas alarm panels have working alarms and indicator lights?


H1. ** Can you tell me the number you would dial to initiate an emergency response?

H2. Are Emergency light (Flashlights) available?


I1. ** How do you notify Security in a non-emergency?

I2. Employees, volunteers, students, contracted staff, physicians, contractors and venders wearing ID badges @ eye level?

I3. Are valuables properly stored in department?

I4. Are latches on Patient doors in working order?


J1. ** What are the procedures if a device/equipment does not work properly OR if the device is involved in a resident related incident?

J2. All medical equipment/devices has a current Bio-Medical sticker?


K1. ** Where are your emergency backup procedures located for a loss of utility services?

K2. ** In case of a fire on the unit, who is authorized to shut off medical gases?


Department/Unit Representative
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.