• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Life Safety Egress Observations

  • Egress free from obstruction(s)?

  • Emergency exits clear of obstruction(s)?

  • Fire and/or Smoke doors free of obstruction(s) & door props and are operating correctly? Latch and Seal properly when closed?<br>

  • Exit doors and stairwells clear?

Life Safety Equipment Observations

  • Fire Extinguishers are charged and inspected?<br>

  • Fire Alarm Pull Stations and Fire Extinguishers unobstructed? <br>

  • Doors NOT propped/held open?

  • Oxygen shut-off valves unobstructed?<br>

  • There are NO unapproved electrical devices on the unit?<br>

  • Exit doors are clearly marked "EXIT" and illuminated?<br>

  • Sprinkler Heads in good repair / dust free?

  • Hand sanitizer NOT over a trash can?<br>

  • Hand sanitizer NOT over carpet without a drip tray?<br>

Life Safety : Staff Knowledge

  • Demonstrate location of fire alarm pull station and fire extinguisher

  • Explain RACE<br><br>Rescue - Alarm - Contain- Extinguish/Evacuate

  • Explain PASS<br><br>Pull<br>Aim<br>Squeeze<br>Sweep

  • Identify Oxygen shut-offs and who is authorized to turn them off?<br><br>Charge nurse or supervisor can authorize the shut off of the oxygen system after confirming patients are on a portable oxygen system

  • Explain the First method of evacuation used in the even of a fire <br><br>Horizontal evacuation to an area separated by sets of smoke doors.

  • Locate Paraslyde Evacuation devices.<br><br>7 & 8 Tower; 4 & 5 Heart; NICU<br>Hospice House

  • Explain who can authorize the use of elevators while a fire alarm is sounding.<br><br>Fire Marshal or the Safety Officer

  • Why are the halls and passageway egress kept clear of clutter and equipment?<br>

  • What is a Code Red?<br><br>Fire

Life Safety Storage Area(s) Observations

  • Storage areas clean and without clutter?<br>No cardboard on floor?

  • Materials are stored at least 18 inches below sprinkler heads?

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