Information
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Organization
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Building/Floor/Area
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Unit
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Manager
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Unit Representative on tour
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Vice President
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Conducted on
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Prepared by
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Personnel on tour
A. PREVIOUS AUDITS
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Has the last audit been reviewed?
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Have all outstanding concerns been addressed?
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Identify outstanding concerns.
B. TOP REPEAT ITEMS
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Hallways clear of clutter.
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Exit doors unobstructed.
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No propped doors.
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Storage (boxes etc.) are stored no less than 18" from sprinkler head.
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Storages (boxes etc.) are 6" above floor.
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No cracked, stained, or missing ceiling tiles.
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No codes written on access control doors.
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All junction boxes are covered.
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No damaged building materials (e.g. ceilings, caulking, corner casing, ceiling penetration, cove base, door, floor tile, handrails, wallboard, wall penetration)
C. STAFF AWARENESS
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Staff can identify Emergency Response Resources.<br>Safety info on ID<br>TJUH Intranet<br>Answer Book<br>Emergency Response Card
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Staff are wearing ID cards.
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Employees know how to access SDSs, Chemical Inventory List available.
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Personal items kept secured in work areas. (Handbags, Wallets)
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Employees know the process for reporting a security incident, chemical spill, Code Red.<br>Dial 811/TJUH Dial 77/MHD
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Staff knows who can shut off medical gases in an emergency.
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Staff demonstrates knowledge of Code D/Disaster response.
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Personal Protective Equipment (PPE) available and worn when necessary.
D. EOC
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Electrical closet/panels, mechanical closets, housekeeping closets are locked.
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Fire extinguishers are clearly marked (signage).
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Fire extinguishers unobstructed within 75 feet.
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Fire extinguisher tag shows monthly inspection (mm/dd/yy) and current annual tag.
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Exits illuminated; clearly and correctly marked.
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Pull stations unobstructed (3' clear) and intact.
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Smoke/Fire Doors close freely (positive latch).
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No smoking policy enforced (no visible signs of non-compliance).
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Fire Tower Exits unlocked from floor (unless approved variance - special conditions).
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Proper stair identification signage at landings.
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Fire evacuation diagram signage posted at elevator call stations/landings.
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Medical gas shut-off valves are labeled to indicate the area served.
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Access control devices (card readers, combination locks) are in use and working properly.
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Area is adequately lighted.
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Sprinkler heads are free of foreign materials.
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No unauthorized appliances (fans, space heater, toaster).
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Extension cords are not substituted for permanent wiring. (only approved surge power strips)
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Entrances to areas storing hazardous chemicals are labeled properly. (NFPA Diamond)
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Chemicals stored properly.
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Gas cylinders properly secured.
E. MEDICAL EQUIPMENT
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Equipment is clean and free from damage.
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Equipment is free of frayed wires and/or faulty plugs.
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Users of equipment is surveyed for recurrent problems.
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Rechargeable equipment is plugged in.
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Equipment is being routinely inspected as indicated by the Equipment management Plan.
F. MISCELLANOUS
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Alcohol based hand washing solution readily available (staff handwashing).
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Clean linen cart covered, no items stored on top.
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No food or drink in clinical work area.
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Refrigerator log completed and up to date.
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Clean and dirty linen are separated and never stored together.
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Standards of cleanliness are maintained throughout.
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HVAC vents free of dust.
G. ADDITIONAL FINDINGS
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Is there any additional findings?
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Additionally findings 1:
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Is there any additional findings?
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Additionally findings 2:
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Is there any additional findings?
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Additionally findings 3:
SIGN OFF
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Department/Unit Representative
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Auditor
