TJC - Tracer - Safety Management

• Department
  Address

• Conducted on

  Date

• Prepared by:

• Location:
  Address

• Personnel

Safety Management

• Are hand rails solidly mounted (not loose)?

  Yes

  No

  N/A

• Is location free from trip hazards?

  Yes

  No

  N/A

• Are walls free from paint or repair needs?

  Yes

  No

  N/A

• Are any cables or wires not exposed?

  Yes

  No

  N/A

• Are oxygen cylinders stored correctly? Empty and full containers physically separated? Open cylinders not stored with full?

  Yes

  No

  N/A

• Are compressed gas cylinders stored and secured properly? Compressed gas cylinders need to be chained to the wall or on a cart secured. Freestanding cylinders are not allowed.

  Yes

  No

  N/A

• Are ceiling tiles clean, stain free, and in good condition? Indicate location of bad tiles in notes section.

  Yes

  No

  N/A

• Are nurse call pull cords proper length - 2 to 6 inches from floor, not tied to grab bars, etc.?

  Yes

  No

  N/A

• Are the total number of oxygen tanks within the allowable limits? No greater than 12 in a smoke compartment outside of storage rooms.

  Yes

  No

  N/A