Audit

FIRE / LIFE SAFETY

Fire extinguishers readily available/unobstructed

Fire extinguishers tagged and inspected monthly

Travel distance to fire extinguisher < or =75'

Doors in egress corridor self-closing or automatic closing

Doors not propped open

Doors in egress corridor positive latching

Fire doors free of obstructions to allow proper closing

Shred-it containers are at least 8 feet away from each other. Trash cans are stored at least 8 feet away from shred-it containers

Ceiling tiles in place/not damaged (limits transfer of smoke)

Evacuation routes posted and current

Hall is free of obstructions that could block free movement

Portable equipment located on one side of the corridor

Stairwell lighting in good condition

Exits free of obstructions

Exits signs adequately illuminated/ marked

Exits signs readily visible from any direction of access

Exit signs provided with a directional indicator that shows direction of travel when nearest exit is not apparent

Fire alarm pull boxes well marked and unobstructed

Medical Gas Zone Valves: staff can describe location, rooms they serve, and who can operate the valves

Fire sprinkler heads in good condition and unobstructed and have 18" clearance below head

Fire sprinkler heads are clean

Patient privacy curtains have 18" netting at top.

Alcohol-Based Dispensers installed per standards

No smoking policy enforced

Other

ELECTRICAL SAFETY

Equip is in good working order with no visible electrical hazards

Electrical safety checks performed by Biomed/Facilities as required

Electrical plugs and cords in good repair

Biomed/Facilities notified of defective equipment

Electrical extension cords are not in use, except where permitted. power Strips are not daisy chained.

Use of portable heating devices prohibited in patient treatment areas; except physician-ordered treatment devices

Portable heating devices in office/non-patient areas approved by Facilities

Blanket Warmers safely used (correct setting <=130 deg., not overloaded, adequate clearance on bottom rack, etc.)

Other:

HAZARDOUS CHEMICALS/HAZARDOUS WASTE

Biohazardous waste properly handled, segragated, stored, disposed

Chemotherapy drugs properly handled, stored, and disposed

Acids, solvents, and other chemicals safely handled, stored and disposed

Chemical spill equipment available and personnel instructed in use

Containers properly labeled (identify and hazard warnings)

O2 shut-off Valves labeled with the proper room numbers

Eyewash stations available, operate, and tested

Access to SDSs (via Internet or Security)

Compressed gas tanks properly stored and secured

Oxygen storage limited to 12 E-cylinders (unless 1 hr. fire rated room)

Medical gas tanks can be identified as full or empty

Medical gas tanks are not stored in the same racks

Other:

GENERAL SAFETY

Storage areas neat and orderly, free of clutter

Appropriate PPE is available for use in the department or area at the time of survey

Storage greater than 18" from fire sprinkler heads

Carts, stretcher, IV poles, chairs, shower chairs etc in good condition

Walking/climbing surfaces (floors, stairs, etc.) clear/safe

Wet floor signs available and used

Handrails in halls present, accessible and properly secure

Eyewash and emergency shower stations being checked weekly

Eyewash stations not obstructed by equipment or other items

Other:

SECURITY

Employees/staff wearing ID badges

Staff personal belongings are secured properly

Panic alarms present/functioning

Rooms/offices secure when unattended

Emergency access to all locked and occupied spaces

Other:

PATIENT CARE ENVIRONMENT (EC.02.06.01)

Interior spaces safe and suitable for patient care/tx/svcs

Storage space appropriate to meet patient needs

Lighting is suitable for care, treatment, and services

Ventilation, temp, / humidity levels suitable for patient care

Interior spaces accommodate equipment, wheelchairs, etc.

Areas clean, sanitary and free of offensive odors

Other:

STAFF KNOWLEDGE EM/EOC QUESTIONS

Do you know where to find SLHS emergency operations plan

Do you know where to find SLHS emergency preparedness guide (red book)

How do you access a SDS (safety data sheet)

Explain how to report an incident or injury involving a visitor, patient, property

Do you know how/when to report and document personal work related injury

What is your depart/unit role in an event of a Mass Casualty Event

If you discover a fire how would you respond

Do you understand the process for partial or complete unit evacuation (horizontal and vertical evacuation)

Where is the nearest fire extinguisher

Do you know the location of fire alarm pull stations & extinguishers

How would you activate a fire alarm

Where are your exits and where do they discharge the building

Can you define Code Pink and what are your dept/areas responsibilities

Can you define Code Black and what are your dept/areas responsibilities

Can you define Code Blue and what are your dept/areas responsibilities

Can you explain what your department does when the hospital activates its severe weather response plan for severe thunderstorm

Can you explain what your department does when the hospital activates its severe weather response plan for tornado

Can you define an active shooter/hostage situation and what is your response/responsibilities

Can staff locate flashlights, batteries, and glow sticks (if applicable) in the event of power loss

What are your responsibilities for a Security Alert-Missing Persons alert

Other:

This form was developed by the SLHS (Environment of Care) EOC Committee to provide a common set of areas to be assessed when conducting annual or semi-annual EOC Safety assessments of departments, entities or spaces owned/ leased by SLHS. The above areas of assessment are the minimum areas to be reviewed during EOC Safety assessments. The areas of assessment listed above may not included all areas or questions asked by those staff conducting the EOC Safety Assessments, instead should be considered a template tool that may include additional Environment of Care areas of focus.

Score each section by dividing the number correct by the total number of areas assessed. It is possible that some areas of assessment listed on this form may not apply to some departments, SLHS entities or lease spaces. In that case these areas should not be included in the total possible for that section being scored.

Scores generated by this form can be used to track overall status of an entity’s Environment of Care program, validate recent changes or education initiatives. These scores may also be used to help identify departments, entities or EOC areas of focus that need improvement. All scores should be communicated to the appropriate SLHS Entity EOC Committee.
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.