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Safety Tour Inspection Checklist
Safety Tour Inspection Checklist
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Created by Brandi Vela, RN, BSN at Delta Health
Quality
Compliance
Customer Created
Table of Contents
Audit Form
Audit Form
Safety Tour Inspection Checklist
Description
Inspect your areas. If there are environmental items please comment.
Required
Observed Date
Name of person Completing the Inspection
Do not enter protected health information (PHI)
Unit
ED
ICU
Med-Surg
PACU
Rehab
Safety Tour Inspection Checklist Checklist
Mark all as...
FIRE SAFETY
Fire extinguishers unobstructed?
Yes
No
N/A
Fire extinguisher inspected within the past month
Yes
No
N/A
Sprinkeler heads unobstructed (18" clearance)?
Yes
No
N/A
Hallways clear of unnecessary obstructions?
Yes
No
N/A
Missing sprinkler head escutcheon plates?
Yes
No
N/A
Exit doors clear of any obstructions?
Yes
No
N/A
Exit lights lit?
Yes
No
N/A
Staff knows where emergency flashlights are?
Yes
No
N/A
Electrical & Equipment Safety
Electrical cords in good condition and not a tripping hazard?
Yes
No
N/A
Staff able to describe and locate emergency outlets (red)?
Yes
No
N/A
Staff knows what to do when equipment malfunctions?
Yes
No
N/A
Staff knows what to do if equipment malfunction causes PATIENT HARM? (FDA Safe Medical Device Act
Yes
No
N/A
Staff know where defective or lock tags are kept?
Yes
No
N/A
Oxygen cylinders are properly stored and secured?
Yes
No
N/A
Infection Control
Staff able to descibe concept of Standard Precautions?
Yes
No
N/A
Personal Protective Equipment available and staff can locate?
Yes
No
N/A
Sharps container in good condition and appropriate location?
Yes
No
N/A
Staff able to demonstrate proper hand washing?
Yes
No
N/A
Staff aware/knowledgeable regarding needlesticks/blood exposure protocol?
Yes
No
N/A
Can employee look up Policies and Procedures on the Intranet?
Yes
No
N/A
Employee drinks are covered and other food items are in approved areas only?
Yes
No
N/A
Temperature checks (logs) are done on patient care refrigs?
Yes
No
N/A
Hazardous Materials
Biohazard labels are appropriately utilized?
Yes
No
N/A
Staff able to describe what SDS are and their location?
Yes
No
N/A
Under sinks and janitor's closets clear of unlabeled or inappropriate chemicals, patient care items?
Yes
No
N/A
Areas with hazardous materials have proper signage?
Yes
No
N/A
General Safety/ Confidentiality
Proper illumination and ventilation for area?
Yes
No
N/A
Patient care items and supplies properly stored?
Yes
No
N/A
All employees in department wearing proper ID badges?
Yes
No
N/A
Staff able to describe a "Security Alert, Missing Baby"?
Yes
No
N/A
Staff aware of the Code for "Security"?
Yes
No
N/A
Patient care information secured and not in public view?
Yes
No
N/A
Items with patient information properly disposed of?
Yes
No
N/A
Any items outdated (supplies or medication )? Look at 3 areas
Yes
No
N/A
Crash Cart: Daily Signatures?
Yes
No
N/A
Crash Cart or IV Carts locked?
Yes
No
N/A
Environmental Inspection
Is there any chipped paint, plaster, loose carpet, etc? If yes, please add comment below
No issues
Issues present
N/A
Comments
Comments related to inspection
Do not enter protected health information (PHI)
