St Mary's Hazard rounds ( Non-clinical )

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Exit corridors

• Are exit signs clear and in plain view in the corridor?

  Yes

  No

  N/A

• Do exit lights work properly?

  Yes

  No

  N/A

• Are all lights in corridor clear of bugs?

  Yes

  No

  N/A

• Are exit corridors free from obstructions?

  Yes

  No

  N/A

• Are exit doors unlocked during normal business hours?

  Yes

  No

  N/A

Cleanliness/conditions.

• Are ceiling tiles broken or stained?

  Yes

  No

  N/A

• Are all cleaning grid clean , not bent or loose?

  Yes

  No

  N/A

• Are wall mounted items securely fastened?

  Yes

  No

  N/A

• Are floors clean?

  Yes

  No

  N/A

• Is there dust anywhere on the floor,furniture, cabinets, ETC?

  Yes

  No

  N/A

• Are trash cans emptied on a regular basis?

  Yes

  No

  N/A

• Is there trash in the corridors?

  Yes

  No

  N/A

• Are there any loose floor tiles?

  Yes

  No

  N/A

Furnishings

• Are furnishing clean?

  Yes

  No

  N/A

• Are any of the furnishing in need of repair?

  Yes

  No

  N/A

• Are there any furnishing that need to be removed from service?

  Yes

  No

  N/A

Fire safety

• Have the fire extinguishers been serviced/checked for the month?

  Yes

  No

  N/A

• Are sprinkler heads free from dust?

  Yes

  No

  N/A

• Is there 18" of clear space around sprinkler heads?

  Yes

  No

  N/A

• Are fire doors working properly?

  Yes

  No

  N/A

• Are exit doors unlocked?

  Yes

  No

  N/A

• Are any doors blocked?

  Yes

  No

  N/A

• Are any doors propped open?

  Yes

  No

  N/A

Utilities

• Are all lights working properly?

  Yes

  No

  N/A

Infection control safety

• Hand sanitizer available?

  Yes

  No

  N/A

Hazardous materials

• Sharps/Bio-waste is properly contained?

  Yes

  No

  N/A

• Are cleaning supplies properly labeled?

  Yes

  No

  N/A

• Are all staff wearing ID badges?

  Yes

  No

  N/A

• Do visitors have ID tags?

  Yes

  No

  N/A

• Magnetic locks and coded locks are working as designed?

  Yes

  No

  N/A

• Are there valuables exposed to the public?

  Yes

  No

  N/A

• All cameras are mounted securely?

  Yes

  No

  N/A

• Eyewash stations are operating correctly.

  Yes

  No

  N/A

• Eyewash stations are inspected based on set time frames.

  Yes

  No

  N/A

Patient safety

• All exit lights are working?

  Yes

  No

  N/A

• Floors are not torn or missing tile, vinyl and or wood. Carpeting is free of tears or loose fabric.

  Yes

  No

  N/A

Electrical safety

• Are there extension cords being used in the area?

  Yes

  No

  N/A

• Electrical cords, multiplug strips computer servers and ups are mounted off the floor.

  Yes

  No

  N/A

• Electrical outlets and plates aren't loose?

  Yes

  No

  N/A

• Items are not stored in front of electrical panels?

  Yes

  No

  N/A

• Electrical panels are locked?

  Yes

  No

  N/A

Equipment safety

• Does equipment in the area have a currant Bio-med inventory sticker?

  Yes

  No

  N/A

• Wheels on equipment are clean of lint and strings?

  Yes

  No

  N/A

• Carts are clean and free of rust?

  Yes

  No

  N/A

• Stretcher mattress is free of cuts, tears?

  Yes

  No

  N/A

• Hospital beds are clean and in proper working order. Pillow speaker works.

  Yes

  No

  N/A

General concerns or questions

Sign off

• Auditor doing the rounds.

  Yes

  No

  N/A

• Add signature

  Sign