SVPHM Safety Rounding Checklist

• Location

• Fitzroy

• East Melbourne

• Kew

• Offsite

• Department / location

• Document No.

• Conducted on

  Date

• Conducted by

• Location
  Address

• Personnel involved in inspection

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Yes

  No

  N/A

• 1.2 - Are there outstanding actions?

  yes

  no

• What is being done to address the required action?

2.0 - Emergency Preparedness

• 2.1 - Fire doors are not blocked by carts, equipment, or materials or propped open?

  Yes

  No

  N/A

• 2.2 - Extinguishers clear of obstructions?

  Yes

  No

  N/A

• 2.3 - Fire Exit signs are illuminating and working properly?

  Yes

  No

  N/A

• 2.4 - Emergency Exit Corridors / Doors are clear?

  Yes

  No

  N/A

3.0 - Safe patient handling

• 3.1 - Manual handling equipment available (slide sheets, hoists, sit to stand machine, etc.)?

  Yes

  No

  N/A

• 3.2 - All staff competent in use of equipment (practical manual handling training completed this year)?

  Yes

  No

  N/A

4.0 - General

• 4.1 - All staff aware of their HSR?

  Yes

  No

  N/A

• 4.2 - Have recent hazards and risks been identified?

  yes

  no

• What has been done to manage the hazard or risk?

• 4.3 - Are any processes, equipment, tasks or environmental / workplace factors causing delays, frustration or concern for staff?

  yes

  no

• What are the issues / concerns?

• 4.4 - Have there been any injuries in the department?

  yes

  no

• What has been identified and implemented to ensure that the cause of the injury does not happen again?

• 4.5 - Are staff aware of the Safety Charter.

  Yes

  No

  N/A

• 4.6 - How many hours have been spent on WHS in the department? <br>(Minimum of 2 hours per month)

  Yes

  No

  N/A

• Number of hours

Comments

• Additional Comments

• Signature

  Sign