Dnv survey readiness tool for building tour checklist
Audit tool
What does this form include?
This form contains 2 sections:
ENVIRONMENT OF CARE
- Area is clean and sanitary No bugs in lights Surfaces free of dust No clutter
- No items stored under sinks?
- Equipment / Furniture: * No broken equipment or furniture stored on the patient care units. * Coverings are intact - no rips or repairs needed.
- Hazardous rooms are locked: EVS closets, supply closets, mechanical rooms and electrical panels.
- Hazardous chemicals and flammable agents are labeled and stored properly.
- Eyewash stations: Inspection tags are present and up to date.
- Refrigerators: Contain only those items designed for that refrigerator (specimen, medications or patient food)
- Refrigerators: If manually monitored, logs are complete. Both manual and temp track-documentation is present for actions taken to correct out of range temps.
- Plugs and elective receptacles are in good condition
- Electrical cords in good condition
- No evidence of daisy chain
- No outer shipping carton boxes in patient care areas.
- No expired items.
- Preventative Maintenance: * Equipment checked with up to date bio-med sticker.
- No evidence of trip hazards
LIFE SAFETY
- Sprinkler heads are free of dust
- Sprinkler heads have escutcheons or guards as needed
- Smoke detectors are 36 inches from intake or exhaust
- No fire wall penetrations
- Alcohol foam is at least 6 inches from ignition source and at least 4 feet apart
- Appropriate storage of boxes and pt care items: * Not directly on floor. * 18" clearance from ceiling * Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage from mopping. * Volume of combustible material is not stored in large quantity as to create a fire hazard.
- Oxygen or other combustible compressed gas cylinders are stored properly: * Secured in floor stand, carrier or secured to the wall by a mount. (not laying on the floor or against wall) * Limited to 12 E-cylinders per smoke compartment. * Greater than 12 stored in a secured room.
- Fire exits and hallways are cleared: * Egress corridors must have 4 ft clearance. * Equipment in corridors must be actively accessed to be in use.
- Fire alarm pull stations, fire extinguishers, medical gas shutoff valves are not blocked.
- Fire extinguishers have been inspected monthly.
- Fire doors are not blocked or propped
- Fire doors close properly
- Exit signs are illuminated.
- Evacuation route posted & current.
- Ceiling tiles are in place, no cracks, holes, misaligned or visible stains.
- Floors, ceilings, walls, and other surfaces intact and free from holes.
- There is 36 inch clearance around electrical panels
Use this template