Title Page

  • Conducted on

  • Prepared by

  • Means of egress were properly maintained on the unit?<br>(No unattended storage, no blocked safety equipment.

  • Could staff locate the "Unit Specific Emergency Plan?"

  • Could staff identify the information the Unit Plan contains? Such as, number of patients, relocation/evacuation areas and transportation needs?

  • Could staff primary and secondary exit routes? The closest and most appropriate exits?

  • Could staff locate a fire extinguisher?

  • Does staff know how to operate a fire extinguisher?

  • Does staff know location of oxygen/medical gas shit off valves and which rooms the valves control?

  • Does staff know who is authorized to cut off medical gas shit off valves?

  • Does staff know if there are adequate portable oxygen tanks available in the event of an oxygen failure?

  • Does staff know to call *500 for fire emergencies?

  • Does staff know location of pull station to activate the alarm after calling *500?

  • Did staff ensure safety of all patients and visitors? (Close doors, clear corridors, assist with evacuation, or in defend in place area, ensure they were in rooms and off unit?)

  • Note type of staff observed.

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