University Care Monthly Inspection

• Document No.

• Audit Title Monthly Inspection

• Client / Site UMMS - University Care

• Conducted on

  Date

• Prepared by Ted Saunders, CFPS

• Location
  Address

• Personnel

Emergency Lights

• Emergency light is functional

• Main exit vestibule

  Yes

  No

  N/A

• Main exit (interior)

  Yes

  No

  N/A

• Hall to Women's Center

  Yes

  No

  N/A

• Hallway door to Women's Center

  Yes

  No

  N/A

• Cancer Center

  Yes

  No

  N/A

• Stork's Nest (combo)

  Yes

  No

  N/A

• Door to medical records room (combo)

  Yes

  No

  N/A

• Exit from Women's Center waiting room (combo)

  Yes

  No

  N/A

• Exit from Women's Center treatment area

  Yes

  No

  N/A

• Entrance to OB/GYN hall (combo)

  Yes

  No

  N/A

• Wall near OB/GYN (combo)

  Yes

  No

  N/A

• End of OB/GYN hall (combo)

  Yes

  No

  N/A

• OB/GYN room 145 (combo)

  Yes

  No

  N/A

• Patient restroom in OB/GYN

  Yes

  No

  N/A

• OB/GYN exit to lobby (combo)

  Yes

  No

  N/A

• Hall by lab (combo)

  Yes

  No

  N/A

• Inside lab

  Yes

  No

  N/A

• Treatment area to lobby (combo)

  Yes

  No

  N/A

• Opposite nurse's station (combo)

  Yes

  No

  N/A

• Treatment area by hall to lab (combo)

  Yes

  No

  N/A

• End of hall to lunchroom (combo)

  Yes

  No

  N/A

• Community room (combo)

  Yes

  No

  N/A

• Rear hall junction (ceiling mount combo)

  Yes

  No

  N/A

• At rear exit (combo)

  Yes

  No

  N/A

• In kitchenette

  Yes

  No

  N/A

• Rear side exit (combo)

  Yes

  No

  N/A

• Ms. Hickey's office

  Yes

  No

  N/A

• Archway from treatment area to waiting room (combo)

  Yes

  No

  N/A

• Archway to Couaro's desk (combo)

  Yes

  No

  N/A

• Men's restroom

  Yes

  No

  N/A

• Women's restroom

  Yes

  No

  N/A

• Patient restroom near nurse's station

  Yes

  No

  N/A

Exit Lights

• Exit lights are functional

• Door from Cancer Center

  Yes

  No

  N/A

• In Cancer Center

  Yes

  No

  N/A

• Front hall to Women's Center

  Yes

  No

  N/A

Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Fire alarm control room

  Yes

  No

  N/A

• Hall to Women's Center

  Yes

  No

  N/A

• By Stork's Nest

  Yes

  No

  N/A

• Lab hallway

  Yes

  No

  N/A

• Kitchenette

  Yes

  No

  N/A

• Rear side entrance

  Yes

  No

  N/A

• Inside lab

  Yes

  No

  N/A

• Front security desk

  Yes

  No

  N/A

Fire Alarm

• Panel is powered

  Yes

  No

  N/A

• Panel is free of trouble and supervisory signals

  Yes

  No

  N/A

Sprinkler System

• Gauge pressures are normal

  Yes

  No

  N/A

• Gauges are free of leaks

  Yes

  No

  N/A

• Control valves are in their normal open or closed position

  Yes

  No

  N/A

• Control valves are either monitored (tamper switch) or chained

  Yes

  No

  N/A

• Alarm valve is free of leaks and in good condition

  Yes

  No

  N/A

• Add signature

  Sign