Audit

RESULTS

TOTAL NUMBER OF FINDINGS

NUMBER OF EVS WORK ORDERS GENERATED?

NUMBER OF ENGINEERING WORK ORDERS GENERATED?

NUMBER OF EDUCATIONAL OPPORTUNITIES IDENTIFIED?

1. PREVIOUS AUDITS

1.1 Has the last audit been reviewed?

1.2 Are there any outstanding concerns?

A. SAFETY/GENERAL SAFETY

A1. Warning signs or barricades are placed when work creates a hazard (wet floor, maintenance work in ceiling)?

A2. Medication cart is locked, neat and tidy, without expired medicines/products?

A3. Clean linen is covered with nothing on top of cart?

A4. All furniture and equipment is in sound condition? (no chipped or torn surfaces- no leaky faucets)

A5. This area is free from sharp objects?

A6. All wall-mounted devices (lights, TV’s, pictures, signs, containers, handrails, etc.) are secure and not loose?

A7. Cleaning chemicals are properly labeled and are not accessible by residents and visitors?

A8. Quality Control logs for Refrigerators/Freezers, freezers, and warmers are complete and corrective actions documented as appropriate?

A9. Boxes of patient care items/supplies are not stored directly on the floor? (must be elevated 6")

A10. Items are not stored under sink(s)? (If items found - list in comment section.)

B. ELECTRICAL SAFETY

B1. Items are not stored within 30” of an electrical panel?

B2. Electrical cords, plugs, plates and switches are in good repair?

B3. Extension cords only used temporarily but not on a permanent everyday basis?

B4. The underside of beds and counters are free of electrical “wire nests” where feet could be entangled?

C. MEDICATION/MEDICAL SUPPLIES

C1. Medications/medical supplies - have not passed expiration dates?

C2. All syringes, basins, cups, containing medication or solutions are labeled with the name of the contents?

D. INFECTION PREVENTION

D1. Staff food is not stored in patient kitchen or refrigerators?

D2. Refrigerators/Freezers contain thermometers and the refrigerator graphs are up-to-date? (thermometer should be located in the back)

D3. No open or expired patient nourishment containers in refrigerator?

D4. Ice machines are clean, no signs of deposits in tray or dispensing mechanism?

D5. Anti-microbial soap and paper towels are available for hand washing?

D6. Containers used for regulated or infectious waste are covered, leak proof, and clearly labeled as a biohazard?

D7. Disposed sharps are in an approved container?

D8. Sharps containers are secured in their holders, not accessible to residents and not more than three-fourths full?

D9. Staff (including contracting physicians) perform hand hygiene when entering room?

E. ENVIRONMENTAL

E1. Floors free of dirt, dust and litter?

E2. Ledges, walls and air vents free of dust?

E3. Toilets and sinks secure?

E4. Privacy curtains clean and unsoiled?

F. HAZARDOUS MATERIALS

F1. ** How can you access Material Safety Data Sheets (MSDS)?

F2. ** Do you know where your PPE is located?

F3. Material Safety Data Sheets available for all chemicals in this unit?

G. FIRE PREVENTION/ LIFE SAFETY

G1. ** Can you explain when you would implement R.A.C.E. and what does it stand for?

G2. ** Can you explain P.A.S.S. and what does it stand for?

G3. ** Where are the fire extinguishers and pull stations located in your department?

G4. Two exit signs visible from each corridor?

G5. Halls/Corridors uncluttered and accessible?

G6. Wheeled items such as the WOW’s are stored in corridor less then 30 minutes at a time?

G7. Are ceiling tiles in place, not stained and not broken?

G8. Are the sprinkler heads free of dust?

G9. Fire extinguisher (s) recently serviced? (monthly)

G10. Automatic fire doors free from obstacles and positively latch when activated? (Doorways should not be blocked or wedged.)

G11. Eighteen-inch clearance from sprinkler head ensuring no obstruction?

G12. Are compressed gases stored in designated areas only?

G13. Are full and empty cylinders stored separately according to sign/labels?

G14. All lights are working properly?

G15. Flammable and hazardous materials properly stored and labeled?

G16. Fire extinguishers and pull stations clear of obstructions?

G17. Placement of Hand Sanitizer is not adjacent(with-in 6”) to a potential ignition source?

G18. Exits clear of obstructions?

H. EMERGENCY MANAGEMENT PROCEDURES

H1. ** Can you tell me the number you would dial to initiate an emergency response?

H2. ** Where are your IT Downtime Forms? Do you have an IT Downtime Box? Are the forms current?

H3. ** Does your unit/department have a disaster supply kit? What is in it? Where is it?

H4. The unit disaster supply kit is available and locked?

H5. All inventory in the disaster kit works and is accounted for?

H6. Weather radios are plugged in and have good reception?

I. SECURITY MANAGEMENT

I1. ** How do you notify Security in a non-emergency?

I2. Employees, volunteers, students, contracted staff, physicians, contractors and venders wearing ID badges @ eye level?

I3. Are valuables properly stored in department?

J. EQUIPMENT MANAGEMENT

J1. ** What are the procedures if a device/equipment does not work properly OR if the device is involved in a resident related incident?

J2. All medical equipment/devices has a current Bio-Medical sticker?

K. UTILITY MANAGEMENT

K1. ** Where are your emergency backup procedures located for a loss of utility services?

K2. ** In case of a fire on the unit, who is authorized to shut off medical gases?

L. RISK MANAGEMENT

L1. ** Can you show me how to initiate an online Event report?

L2. Patient Health Information is not visible(computer screens protected, hard copies covered, patient charts closed)

M. RESIDENT SAFETY

M1. ** Name two patient identifiers?

M2. ** Describe the Falls Prevention efforts in your department.

N. BRALY UNIT

N1. FREE OF PERVASIVE ODORS?

COMMENTS/OBSERVATIONS

SIGN OFF
Department/Unit Representative
Auditor
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.