Safety & Compliance Inspection - 2016

• Document No.

• Conducted on:

  Date

• Prepared by:

• Client Name:

• Client Address:

• Point of Contact:

• Client Phone Number:

Record Keeping

• Records retained?

  Yes

  No

  N/A

  Not Inspected

Written Plans

• Hazard Communication plan?

  Yes

  No

  N/A

  Not Inspected

• DOT Medical Waste Shipment Protocol?

  Yes

  No

  N/A

  Not Inspected

• Exposure Control plan?

  Yes

  No

  N/A

  Not Inspected

• Emergency Action plan?

  Yes

  No

  N/A

  Not Inspected

• Infection Control plan?

  Yes

  No

  N/A

• Written plans updated & reviewed?

  Yes

  No

  N/A

Required Postings

• OSHA poster?

  Yes

  No

  N/A

  Not Inspected

• Labor law poster?

  Yes

  No

  N/A

  Not Inspected

HIPAA

• No HIPAA violation observed? (do not photograph)

  Yes

  No

  N/A

Accident's

• Any reported accidents or injuries in past 12 months?

  Yes

  No

  N/A

• Any OSHA reportable injuries in the past 12 months?

  Yes

  No

  N/A

SHARPS

• Annual safer device evaluation preformed?

  Yes

  No

  N/A

• Any sharps injuries reported in last 12 months?

  Yes

  No

  N/A

• Proper post exposure procedures followed?

  Yes

  No

  N/A

HAZCOM

• All bottles and containers are properly labeled?

  Yes

  No

  N/A

  Not Inspected

• Chemicals are properly segregated and stored when not in use?

  Yes

  No

  N/A

  Not Inspected

• Chemical storage areas are properly marked?

  Yes

  No

  N/A

  Not Inspected

• SDS location identified?

  Yes

  No

  N/A

• Employees know we're SDS's are kept?

  Yes

  No

  N/A

• MSDS's archived?

  Yes

  No

  N/A

• Acute toxins identified?

  Yes

  No

  N/A

• Annual chemical inventory complete?

  Yes

  No

  N/A

Universal Precautions

• Universal precautions followed?

  Yes

  No

  N/A

  Not Inspected

• Contaminated areas are cleaned between patients or after incidents?

  Yes

  No

  N/A

  Not Inspected

• Food and drink prohibited in clinical / research areas?

  Yes

  No

  N/A

  Not Inspected

• Food is not stored with blood / OPIM / medications / chemicals?

  Yes

  No

  N/A

  Not Inspected

• PPE removed upon leaving clinical / research areas?

  Yes

  No

  N/A

  Not Inspected

• PPE removed prior to costuming food or drink?

  Yes

  No

  N/A

  Not Inspected

Infection Control

• Are areas cleaned and disinfected between patients?

  Yes

  No

  N/A

• Is weekly spore testing conducted & documented?

  Yes

  No

  N/A

• Trash cans not over flowing?

  Yes

  No

  N/A

• Are areas kept clean & organized?

  Yes

  No

  N/A

• General housekeeping?

  Yes

  No

  N/A

• Cold sterilization "change out" log?

  Yes

  No

  N/A

• Disinfectant property stored when not in use?

  Yes

  No

  N/A

BBP HAZCOM

• Bio- hazard labels used as appropriate?

  Yes

  No

  N/A

• Red bio-liners used?

  Yes

  No

  N/A

• Cold sterilization container labeled? (Bio & Chem)

  Yes

  No

  N/A

Eyewash / Drench Hose / Safety Shower

• Accessible within in 10 seconds?

  Yes

  No

  N/A

  Not Inspected

• Locations identified?

  Yes

  No

  N/A

  Not Inspected

• Hands free operation after activation?

  Yes

  No

  N/A

  Not Inspected

• Functioning and performing to the standard?

  Yes

  No

  N/A

  Not Inspected

• Tested and Documented?

  Yes

  No

  N/A

  Not Inspected

• Water at a tepid temperature?

  Yes

  No

  N/A

  Not Inspected

Fire Extinguishers

• Fire extinguishers present?

  Yes

  No

  N/A

• Mounted properly?

  Yes

  No

  N/A

  Not Inspected

• Identified properly?

  Yes

  No

  N/A

  Not Inspected

• Annual inspection current?

  Yes

  No

  N/A

  Not Inspected

• Visual monthly inspection done and documents?

  Yes

  No

  N/A

  Not Inspected

• No more then 50' between fire extinguishers?

  Yes

  No

  N/A

  Not Inspected

First Aid

• First aid kit available?

  Yes

  No

  N/A

• First aid kit location identified?

  Yes

  No

  N/A

• AED present?

  Yes

  No

  N/A

• AED functional?

  Yes

  No

  N/A

• AED pad & batteries not expired?

  Yes

  No

  N/A

Exits

• Exit route clearly marked and unobstructed?

  Yes

  No

  N/A

  Not Inspected

• 28" minimum exit route passage clearance?

  Yes

  No

  N/A

  Not Inspected

• Unlocked from the inside during business hours?

  Yes

  No

  N/A

  Not Inspected

• Proper signage and lighting?

  Yes

  No

  N/A

  Not Inspected

• Exit signs present & properly working?

  Yes

  No

  N/A

• Emergency lighting present & properly working?

  Yes

  No

  N/A

• Egress maps posted?

  Yes

  No

  N/A

Compressed Gas Cylinders

• Contents label clearly visible?

  Yes

  No

  N/A

• Cylinders secured?

  Yes

  No

  N/A

• Cylinders capped when not in use?

  Yes

  No

  N/A

Electrical Safety

• Electrical panels unobstructed?

  Yes

  No

  N/A

• Electrical cords used properly and do not pose a trip hazard?

  Yes

  No

  N/A

• Flammable liquids not stored around surge protectors?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Adequate number & types of PPE present?

  Yes

  No

  N/A

• Employees wearing PPE?

  Yes

  No

  N/A

• PPE stored properly?

  Yes

  No

  N/A

Laser Safety

• Lasers present?

  Yes

  No

  N/A

• Manufacturer and class of laser?

  Yes

  No

  N/A

• Our employees trained?

  Yes

  No

  N/A

• Proper PPE & Postings?

  Yes

  No

  N/A

X-Ray

• Notice to employees? <br>PA - 2014 version<br>OH - 2006 version<br>WV -

  Yes

  No

  N/A

• Lead aprons properly stored when not in use?

  Yes

  No

  N/A

• Proper warnings posted?

  Yes

  No

  N/A

• Dosimeter badge program in place?

  Yes

  No

  N/A

Universal Waste

• Universal waste accumulated onsite?

  Yes

  No

  N/A

  Not Inspected

• Universal waste properly managed and disposed of?

  Yes

  No

  N/A

  Not Inspected

Infectious / Medical Waste

• Proper medical waste management practiced?

  Yes

  No

  N/A

  Not Inspected

• Manifests retained for 5 years?

  Yes

  No

  N/A

  Not Inspected

• Sharps containers properly used?

  Yes

  No

  N/A

  Not Inspected

• Nothing stored on top of sharps containers or medical waste boxes?

  Yes

  No

  N/A

• All medical waste containers properly labeled?

  Yes

  No

  N/A

  Not Inspected

• Only medical waste placed in waste containers?

  Yes

  No

  N/A

  Not Inspected

• Waste shipped offsite for treatment every 30 days?

  Yes

  No

  N/A

  Not Inspected

Hazardous waste

• Hazardous waste generated onsite?

  Yes

  No

  N/A

• Hazardous waste properly managed with segregation and secondary containment?

  Yes

  No

  N/A

Signatures

• Inspector Signature:

  Sign

• Reviewer Signature:

  Sign

Notes

• Yes

  No

  N/A

• Add media

  Media