FACILITY INSPECTION CHECKLIST

FACILITY INSPECTION CHECKLIST

Inspector:

Date:

This inspection checklist monitors the compliance activities at the facility.  It also serves as a hazard assessment to current activities.  The inspection shall be completed in all areas of the facility, including warehouse and office areas as it is applicable.  Issues shall be summarized on the last page.  Corrections will be made and documented completion date on the summary page.   All corrections are expected to be completed in a timely manner.

EMERGENCY EXIT	Yes	No	N/A	Comments
All exit signs well placed and visible easily at all time?
All exit signs free of damage?

                                                                                                       

EMERGENCY PREPAREDNESS	Yes	No	N/A	Comments
Are all aisle ways free of obstructions?
Are all exits free of storage and clutter?
Are stairwells and corridors free of storage and clutter?
Are all employees trained on Emergency Evacuation Procedures?
Are all employees aware of the proper meeting location in the event of an emergency?
Is the fire alarm is working condition?
Is there anything else relating to emergency preparedness that needs attention at this time?

FIRE EXTINGUISHERS	Yes	No	N/A	Comments
Are all extinguishers in their designated location?
Are all extinguishers clearly identified with a wall mounted sign?
Are all extinguishers securely mounted to the wall?
Are all extinguishers easily accessible and free of obstructions?
Is the last annual inspection within the past 12 months?
Are inspection tags current with initial and date of inspection?
Are all seals and tamper pins in place?
Are all extinguishers free of damage, corrosion, leakage or clogged nozzles?
Do all pressure gauges indicate the extinguishers are ready for use?
Are all staff members trained on fire extinguisher use?
Is there anything else that needs attention at this time?

HAZARDOUS MATERIALS	Yes	No	N/A	Comments
Are MSDS available on all hazardous materials in the facility?
Are all MSDS readily available for all employees?
Are all employees trained on how to locate, read and understand an MSDS sheet? (Hazard Communications)
Are all personnel equipped with adequate PPE for these materials?
Are all spill kits located in the correct area?
Are all spill kits fully stocked with the needed equipment?
Is there anything else relating to hazardous materials that needs attention at this time?

HOUSEKEEPING	Yes	No	N/A	Comments
Are all areas cleaned on a regular basis?
Are all walkways are free of other items that could cause a tripping hazard?
Are all floors free of liquids to avoid trips and falls?
Is housekeeping staff having and using PPE?
Are housekeeping items properly atored and easily available to the staff?
Flammable materials such as cardboard and paper are stored away from fire hazards.
Are there any other housekeeping issues that need to be addressed?

ELECTRICAL	Yes	No	N/A	Comments
No circuit breakers regularly tripping?
No extension cords used for a permanent operation?
Are all plugs and cords in good condition?
No electrical switches, switch plates or receptacles, cracked, broken or have exposed contacts?
Are all electrical circuit breakers identified?
Are there any other electrical issues that need attention at this time?

PERSONAL PROTECTIVE EQUIPMENT	Yes	No	N/A	Comments
Is there adequate PPE for all job types on site?
Are all personnel trained in the proper use of all PPE as required by their job(s)?
Is signage displayed in areas where PPE is required?
Are employees wearing proper footwear in accordance with PPE requirements?
Are employees wearing gloves wear required by the tasks?
Are there any other PPE issues that need to be addressed at this time?

SECURITY	Yes	No	N/A	Comments
Are all entry ways secured from unauthorized access?
Are surveillance video cameras in working order?
Are video recording devices in working order and storing video accordingly?
Are there any other security issues to be addressed?

Other Equipment Maintenance	Working	Broken	N/A	Comments
Fans
Tables
Lighting
Carts
Dust Bins
Computer Equipment
Patients Beds
Stretchers
Wheel Chairs
RO Water

Air Compressor	Yes	No	N/A	Comments
Was the air compressor drained of fluid?
Is the pressure gauge in working order?
Is the operating pressure within manufacturer’s specifications?
Is the safety valve in working order?
Are there any leaks in the lines?
Is complaint register daily checked?

Date of Review:

Mgmt. Reviewer:

	Unsafe condition or work practice	Person Assigned	Corrective Actions	Due Date	Resolution Date
1
2
3
4
5
6
7

                                                                                                                                SIGNATURE

                                                                                                            MEDICAL SUPERINTENDENT