FACILITY INSPECTION CHECKLIST
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Inspector:
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Date:
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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.
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EMERGENCY EXIT
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Yes
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No
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N/A
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Comments
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All exit signs well placed and visible easily at all time?
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All exit signs free of damage?
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EMERGENCY PREPAREDNESS
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Yes
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No
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N/A
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Comments
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Are all aisle ways free of obstructions?
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Are all exits free of storage and clutter?
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Are
stairwells and corridors free of storage and clutter?
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Are all employees trained on Emergency Evacuation Procedures?
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Are all employees aware of the proper meeting location in the
event of an emergency?
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Is the
fire alarm is working condition?
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Is there anything else relating to emergency preparedness that
needs attention at this time?
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FIRE EXTINGUISHERS
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Yes
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No
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N/A
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Comments
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Are all extinguishers in their designated location?
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Are all extinguishers clearly identified with a wall mounted
sign?
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Are all extinguishers securely mounted to the wall?
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Are all extinguishers easily accessible and free of
obstructions?
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Is the last annual inspection within the past 12 months?
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Are inspection tags current with initial and date of inspection?
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Are all seals and tamper pins in place?
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Are all extinguishers free of damage, corrosion, leakage or
clogged nozzles?
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Do all pressure gauges indicate the extinguishers are ready for
use?
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Are all staff members trained on fire extinguisher use?
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Is there anything else that needs attention at this time?
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HAZARDOUS MATERIALS
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Yes
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No
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N/A
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Comments
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Are MSDS available on all hazardous
materials in the facility?
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Are all MSDS readily available for all
employees?
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Are all employees trained on how to
locate, read and understand an MSDS sheet? (Hazard Communications)
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Are all personnel equipped with adequate
PPE for these materials?
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Are all spill kits located in the correct
area?
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Are all spill kits fully stocked with the
needed equipment?
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Is there anything else relating to
hazardous materials that needs attention at this time?
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HOUSEKEEPING
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Yes
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No
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N/A
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Comments
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Are all areas cleaned on a regular basis?
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Are all walkways are free of other items
that could cause a tripping hazard?
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Are all floors free of liquids to avoid
trips and falls?
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Is housekeeping staff having and using
PPE?
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Are housekeeping items properly atored
and easily available to the staff?
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Flammable materials such as cardboard and
paper are stored away from fire hazards.
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Are there any other housekeeping issues
that need to be addressed?
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ELECTRICAL
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Yes
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No
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N/A
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Comments
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No circuit breakers regularly tripping?
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No extension cords used for a permanent operation?
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Are all plugs and cords in good condition?
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No electrical switches, switch plates or receptacles, cracked,
broken or have exposed contacts?
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Are all electrical circuit breakers identified?
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Are there any other electrical issues that need attention at
this time?
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PERSONAL PROTECTIVE EQUIPMENT
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Yes
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No
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N/A
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Comments
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Is there adequate PPE for all job types
on site?
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Are all personnel trained in the proper
use of all PPE as required by their job(s)?
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Is signage displayed in areas where PPE is required?
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Are employees wearing proper footwear in accordance
with PPE requirements?
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Are employees wearing gloves wear required by the
tasks?
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Are there any other PPE issues that need
to be addressed at this time?
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SECURITY
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Yes
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No
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N/A
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Comments
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Are all entry ways secured from unauthorized access?
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Are surveillance video cameras in working order?
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Are video recording devices in working order and storing video
accordingly?
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Are there any other security issues to be addressed?
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Other Equipment Maintenance
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Working
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Broken
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N/A
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Comments
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Fans
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Tables
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Lighting
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Carts
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Dust Bins
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Computer
Equipment
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Patients
Beds
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Stretchers
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Wheel
Chairs
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RO
Water
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Air
Compressor
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Yes
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No
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N/A
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Comments
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Was the
air compressor drained of fluid?
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Is the
pressure gauge in working order?
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Is the
operating pressure within manufacturer’s specifications?
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Is the
safety valve in working order?
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Are
there any leaks in the lines?
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Is
complaint register daily checked?
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Date
of Review:
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Mgmt.
Reviewer:
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Unsafe condition
or work practice
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Person Assigned
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Corrective Actions
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Due Date
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Resolution Date
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1
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2
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3
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4
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5
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6
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7
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SIGNATURE
MEDICAL SUPERINTENDENT