Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Life Safety Egress Observations
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Egress free from obstruction(s)?
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Emergency exits clear of obstruction(s)?
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Fire and/or Smoke doors free of obstruction(s) & door props and are operating correctly? Latch and Seal properly when closed?<br>
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Exit doors and stairwells clear?
Life Safety Equipment Observations
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Fire Extinguishers are charged and inspected?<br>
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Fire Alarm Pull Stations and Fire Extinguishers unobstructed? <br>
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Doors NOT propped/held open?
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Oxygen shut-off valves unobstructed?<br>
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There are NO unapproved electrical devices on the unit?<br>
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Exit doors are clearly marked "EXIT" and illuminated?<br>
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Sprinkler Heads in good repair / dust free?
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Hand sanitizer NOT over a trash can?<br>
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Hand sanitizer NOT over carpet without a drip tray?<br>
Life Safety : Staff Knowledge
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Demonstrate location of fire alarm pull station and fire extinguisher
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Explain RACE<br><br>Rescue - Alarm - Contain- Extinguish/Evacuate
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Explain PASS<br><br>Pull<br>Aim<br>Squeeze<br>Sweep
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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
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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.
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Locate Paraslyde Evacuation devices.<br><br>7 & 8 Tower; 4 & 5 Heart; NICU<br>Hospice House
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Explain who can authorize the use of elevators while a fire alarm is sounding.<br><br>Fire Marshal or the Safety Officer
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Why are the halls and passageway egress kept clear of clutter and equipment?<br>
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What is a Code Red?<br><br>Fire
Life Safety Storage Area(s) Observations
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Storage areas clean and without clutter?<br>No cardboard on floor?
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Materials are stored at least 18 inches below sprinkler heads?