Spectrum Health BR and RC IP rounding

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Unit

Environmental compliance

• Are items stored at least six inches off the floor?

  Yes

  No

  N/A

• Are items stored 18 inches below ceiling?

  Yes

  No

  N/A

• Are windows sills free of items?

  Yes

  No

  N/A

• Is overall appearance of unit clean and uncluttered?

  Yes

  No

  N/A

• Are hallways free of items?

  Yes

  No

  N/A

• Are ceiling tiles free from stains?

  Yes

  No

  N/A

• Is the area free from visible dust?

  Yes

  No

  N/A

• Are vents in the area clean and dust free?

  Yes

  No

  N/A

• Are work surfaces uncluttered and clean?

  Yes

  No

  N/A

• Are patient care areas free from staff food, drinks, and other belongings?

  Yes

  No

  N/A

Equipment compliance

• Is furniture safe and secure without worn or torn spots?

  Yes

  No

  N/A

• Are clean and dirty supplies stored separately?

  Yes

  No

  N/A

• Is dirty linen contained within hampers and soiled linen off the floor?

  Yes

  No

  N/A

• Have supplies been checked for outdated and rotated?

  Yes

  No

  N/A

• Items are not being stored within the splash zone (3 feet) of the sink?

  Yes

  No

  N/A

Sharps/Biohazard compliance

• Are sharps containers replaced when 2/3 full?

  Yes

  No

  N/A

• Are sharps containers secured?

  Yes

  No

  N/A

• Are biohazards labeled and handled appropriately/disposed of properly?

  Yes

  No

  N/A

Temperature compliance

• Are temperature logs up to date with actions taken when not in range?

  Yes

  No

  N/A

• Is the medication refrigerator labeled and free of food items?

  Yes

  No

  N/A

• Is the biohazard/breast milk refrigerator labeled and free of food items?

  Yes

  No

  N/A

• Do airborne precaution rooms have all door closed?

  Yes

  No

  N/A

• Is linen being transported covered?

  Yes

  No

  N/A

• Is linen stored and covered appropriately?

  Yes

  No

  N/A

Comments/concerns

• Are there any additional comments or concerns?

  Yes

  No

  N/A

Personnel

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