Fire Prevention
Fire doors close and latch?
YesNoN/ASmoke doors close?
YesNoN/ADoors wedged?
SafeAt RiskN/AExit signs illuminated?
YesNoN/AFire alarms accessible?
YesNoN/AFire extinguishers accessible?
YesNoN/AFlammables stored appropriately?
YesNoN/AMedical gas stored appropriately?
YesNoN/AAppropriately Use of bulk medical gas storage rooms?
YesNoN/ASmoke detectors unobstructed?
YesNoN/ASprinklers unobstructed?
YesNoN/AAppropriate use of decorations?
YesNoN/AFire and smoke barrier penetrations sealed?
YesNoN/A
Security Management
Medications secured?
YesNoN/ASyringes and needles secured?
YesNoN/AMedical records secured?
YesNoN/AStaff wearing IDs?
YesNoN/ABelongings secured?
YesNoN/A
Log Sheet Documentation
Crash carts - daily?
YesNoN/ARefrigerators - daily?
YesNoN/AFire Extinguishers - monthly?
YesNoN/A
Safety Management
Electrical cords and plugs in a safe condition?
YesNoN/AExtension cords are not in use?
YesNoN/AGFI outlet within 6' of water source?
YesNoN/AElectrical panels accessible [3']?
YesNoN/ACorridors unobstructed?
YesNoN/AEmergency reference guides available?
YesNoN/AFlashlights available?
YesNoN/ALifting equipment available?
YesNoN/AStairwells clear?
YesNoN/AStep stools available?
YesNoN/AStorage and mechanical rooms clean?
YesNoN/A
Utilities Management
Ceiling tiles stained?
SafeAt RiskN/AOxygen shut off valves labeled?
YesNoN/A
Clinical Equipment
Current PM sticker?
YesNoN/AAlarms disabled?
SafeAt RiskN/A
Hazardous Materials
Appropriate use of utility rooms?
YesNoN/ASharps containers overfilled?
SafeAt RiskN/APPE available?
YesNoN/AProducts properly labeled and stored?
YesNoN/A
Infection Control
Hand-washing observed?
YesNoN/AIsolation precautions followed?
YesNoN/ALinen covered?
YesNoN/A
Waste Management
Appropriate items in general trash?
YesNoN/AAppropriate items in red bags?
YesNoN/AAppropriate items in RCRA cans?
YesNoN/AAppropriate items in sharps container?
YesNoN/AAppropriate handling of waste streams?
YesNoN/A
Recommended Follow-up?
Follow-up for manager?
Follow-up for Facilities?