Inspection

Safety 1. In controlled building areas where friable asbestos containing materials exist, appropriate warning labels and signage is present (e.g. ceiling spaces, boiler rooms, tunnels, crawl spaces, etc.)?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 2. Areas are clean and free of offensive odors?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 3. Emergency access is provided for all locked and occupied spaces? (e.g. patient bathrooms, seclusion rooms, etc.)

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 4. Emergency eyewash and shower equipment is accessible, and inspected/tested monthly?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 5. Area staff are familiar with the location and use of emergency eyewash and shower equipment?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 6. Medical gas cylinders are properly secured when in use, in storage and in transport?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 7. If stored within the same enclosure, empty and partial medical gas cylinders are segregated from full cylinders and are marked to avoid confusion and delay?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 8. Blanket warming cabinet temperatures are maintained at or below 130F, logs are current and actions are documented for failed readings?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 9. Practices are in place to protect patient privacy and confidentiality?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 10. Smoking:▪ Facility's smoking policy is effectively enforced▪Appropriate ""NO SMOKING" signage is posted

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 11. A minimum of 18" clearance is maintained between fire sprinkler heads and adjacent storage?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 12. Empty patient rooms are not used for the storage of combustible materials?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 13. Nurse-call emergency pull stations comply with the following:▪ Equipped with pull cords that do not pose a ligature risk▪ Pull cords not long than 6

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 14. Wall mounted projections into corridors ≥ 6 feet wide:▪ Project no more than 6" into the corridor▪ Are no more than 36" wide ▪ Are installed at least 48" apart▪ Are installed above handrail height

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 15. If you are injured at work , what do you do?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…

Safety 16. Where do you the UOR report and Form 133?

What is the likelihood to harm a patient / staff / Visitor?
Is the problem…
General Comments Not Included in the Checklist

Safety 17. Do you have any additional comments? If so, please add them here.

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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.