Staff able to demonstrate knowledge and skill in their role and expected participation in:

Infection control program?

What nationally recognized infection control standards are used in the facility?

Able to list when hand washing is required?

Able to state safe medication administration practice related to infection control?

Safety management program?

Security management program?

Hazardous materials and waste management program?

Staff able to locate MSDS for chemical used in area?

Emergency preparedness program?

Emergency procedures readily available and staff knowledgeable of location and contents?

Life safety program?

Staff aware of nearest fire pull, extinguisher and gas shut-off?

Demonstrate proper function and control of fire enunciator panel?

Utility management program?

Medical equipment management program?

How are equipment malfunctions handled?

How are you trained to operate equipment? What do you do if unsure of operation?

Staff able to demonstrate locating specific policies and procedures?


Infection Control

Employees able to state contact times for cleaning chemicals?

Sharps containers not more that 3/4 full?

All sharps containers secured to walls/carts?

All areas free from odors?

Bi-Monthly cleaning checklists complete for all areas: Pre-post, OR, Pain, GI, Med Rooms, Supply Rooms, SPD/Decontamination?

Temperature and humidity logs complete for OR, Sterile Supply, SPD and Decontamination?

Refrigerator log temperature checks up to date and complete with memory checked and cleared?

Medication refrigerators with no food items and proper storage of medications?

Solid surfaces present on the bottom of all storage carts?

Patient care items stored appropriately away from possible contaminants?

Fluid warmers with current temperature logs and no expired fluids (14 days)?

Tissue freezer with complete and up to date temperature checks, current AATB/FDA documentation, complete inventory and implant log?

Expiration dates present on all patient food refrigerator items?

No items stored under sinks?

Exposure control plan accessible and up-to-date?

Sinks in proper working condition?

Speak-Up education provided t all patients upon admission?

Ceiling tiles free of stains/dust?

All floors properly maintained?

PPE's available in all areas?

Red bags available in all areas?

Universal precautions observed at all times?

No food present in patient care areas?

Drink containers covered at all times?

Linen storage is covered at all times?

Clean to dirty flow is maintained and all dirty equipment covered for transport?

Air pressures maintained per standards?

Mattresses and pillows free of tears?

Proper hand washing observed?

Sterile Processing

All items cleaned per manufacturer guidelines?

Chemical indicator placed in each load with complete and accurate log of such?

BI is performed daily and with all implants?

Cidex logs complete with temperature checks and chemical indicator?

Washer and autoclave cleaning logs complete and accurate?

Cleaning agents are properly measured in sink?

Sinks are properly labeled?


Equipment with current Biomed tags?

Electrical equipment in proper working condition with no frayed electrical cords?


Staff appear to be working ergonomically safe?

All furniture in proper condition?

Weather radios on and functioning?

Walkie-Talkies plugged in and functioning properly?

Exit doors unobstructed?

Halls free of equipment? 8 foot clearance?

Exit signs visible with proper illumination?

Fire extinguishers checked monthly?

Fire extinguishers not blocked by equipment?

Fire drill logs up-to-date? 2 per shift per quarter.

Evacuation route maps posted in all areas?

Child-safe outlet protectors in place in all areas?

Spill kits present in areas of potential spills (Formaldehyde, blood/body fluids, Cidex)

No doors propped open/no wedges in use?

All doors positively latching?

No fire wall penetrations present?

18" clearance from ceiling for all stored items?

No cardboard present in clean storage/restricted areas?

Emergency carts

Pre-op Crash Cart locked with current inventory, algorithms, daily and expiration date checklists?

Pre-op crash cart with full oxygen cylinder, portable suction and functioning defibrillator?

Pain Crash Cart locked with current inventory, algorithms, daily and expiration date checklists?

Broselow Cart locked with current algorithms, inventory and daily and expiration date checklists?

MH cart locked with current inventory and expiration date checklist?

Pain Crash Cart with full oxygen cylinder and portable suction?

Chest tube kit with current lock, inventory and expiration date checklist?

Emergency trach kit with current lock, inventory and expiration date checklist?

Emergency chest tube kit with current lock, inventory and expiration date checklist?

Gas cylinders clean, stored upright and labeled?

Empty gas cylinders removed when empty?

Eyewash stations tested daily and flushed weekly?

All chemicals stored and labeled appropriately? Stored at eye level or lower?

Flammable chemicals stored in fire cabinet?

Storage areas free of clutter and no itms stored on floor?

Cord management present in all areas; no tripping hazards?

Hot water temperature 120 degrees or less?

Corridor hand rails and bathroom grab bars intact and secure?

Patient call lights in reach of patients at all times?

Patient stretchers in lowest position when unattended?

Medication Safety

All medication areas have current expiration date checklists?

All medication areas clean with monthly cleaning checklists complete?

Supplies stored appropriate and with aseptic technique?

Medication refrigerator temperature logs complete with memory checked and cleared?

Medication refrigerators clean?

Normal saline vials are used one per patient?

RN identify patients using 2 patient identifiers each time a medication is administered?

Single use vials are used only one time?

All medications labeled appropriately?

2 RN verification on labels of medications not administered by preparer?

Medications reviewed by entering and exiting personnel?

Medications on the sterile field/procedural area are labeled?

Unlabeled medications are discarded immediatley?

Medication preparation areas clean and free of debris?

All mediations stored in locked storage areas?

No expired mediations present?

Medications stored by route and different routes separated?

Look-alike/sound-alike practices observed?

CLIA Waived Tests

Blood glucose logs complete?

Owners manual present with machine?

Cleaning of machine documented with each use?

National Patient Safety Goals

2 patient identifiers used when administering meds, labeling specimens, providing treatments?

Specimens are labeled in the presence of the patient?

Procedural sites are marked by MD with patient involvement?

Time-Outs are performed in all areas prior to the start of procedure?

Employees knowledgeable of Universal Protocol?

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.