Title Page
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Conducted on
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Prepared by
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Means of egress were properly maintained on the unit?<br>(No unattended storage, no blocked safety equipment.
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Could staff locate the "Unit Specific Emergency Plan?"
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Could staff identify the information the Unit Plan contains? Such as, number of patients, relocation/evacuation areas and transportation needs?
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Could staff primary and secondary exit routes? The closest and most appropriate exits?
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Could staff locate a fire extinguisher?
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Does staff know how to operate a fire extinguisher?
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Does staff know location of oxygen/medical gas shit off valves and which rooms the valves control?
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Does staff know who is authorized to cut off medical gas shit off valves?
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Does staff know if there are adequate portable oxygen tanks available in the event of an oxygen failure?
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Does staff know to call *500 for fire emergencies?
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Does staff know location of pull station to activate the alarm after calling *500?
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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?)
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Note type of staff observed.