Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Work areas are neat and orderly<br>

  • Add media

  • Is there a step stool/ ladder available for reaching overhead objects?

  • Add media

  • Is eating and drinking prohibited in work areas?

  • Add media

  • Supplies and stock not stored on floors or under sinks (small quantities of cleaning products only)?

  • Add media

  • All lights are operating properly?

  • Add media

  • Storage rooms are clean and orderly and shelving is secure?

  • Add media

  • Temporary equipment in corridor is placed on one side of hall?

  • Add media

  • Check Nurse call system including bath room alarms.

  • Add media

  • No sharp edges on furniture or equipment?

  • Add media

  • Computer, electrical and phone cords are secured and bundled when appropriate?

  • Add media

  • Office and work stations are ergonomically correct. Chairs are adjustable and employees know how to make adjustments? Casters roll freely?

  • Add media

  • Tile and carpet are in good condition (no missing pieces, holes, flaps or tears) Rugs available and in good condition when needed?

  • Add media

  • Staff clothing and footwear are appropriate?

  • Add media

  • Stretchers, beds, wheelchairs and carts are in good working order?

  • Add media

  • Emergency pull cord present and working in the bath room, not more than 6 inches from floor? (Check at least one patient room).

  • Add media

  • Proper personal Protective equipment (PPE) provided and being worn?

  • Add media

  • Are universal and standard precautions followed?

  • Add media

  • Is excess water removed from floors or shower/ therapy areas?

  • Add media

  • Is area free of Slip, Trip, Fall hazards?

  • Add media

  • Are wet areas identified, barricaded and only mopped 1/2 at a time?

  • Add media

  • Are drawers and cabinet doors kept closed?

  • Add media

  • Teamwork promoted and encouraged?

  • Add media

  • Poll at least two employees to evaluate their knowledge of various employee safety and security programs (role during various codes).

  • Add media

  • Observe employee using proper body mechanics for materials handling.

  • Add media

  • Observe staff repositioning a patient in bed ( I.e., pulling patient up in bed).

  • Add media

  • Observe staff transferring patient to different level (I.e., from chair to bed).

  • Add media

  • Observe a lateral transfer (I.e., bed to stretcher or exam table).

  • Add media

  • Are all employees wearing name badge/ identification?

  • Add media

  • Are vendors and contractors wearing proper identification?

  • Add media

  • Interior and exterior lighting is adequate?

  • Add media

  • Are unauthorized people questioned?

  • Add media

  • Department is secured after hours?

  • Add media

  • Are restricted access rooms (medication, EVS, offices) secured as required?

  • Add media

  • Employee valuables stored in a secure area?

  • Add media

  • Hospital property properly secured?

  • Add media

  • Access controlled to the public and/or unauthorized persons?

  • Add media

  • Safe room available in ED?

  • Add media

  • Is employee able to verbalize signs for identifying agitated individuals and techniques to de-escalate a situation?

  • Add media

  • Controlled access areas are operating accordingly?

  • Add media

  • Additional notes.

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.