BASIC LIFE SAFETY

Finding (circle one)

1.

Is the Fire Emergency Plan posted?

Yes

No

NA

2.

Are corridors and exits free from obstructions?

Yes

No

NA

3.

Are exit signs illuminated and visible?

Yes

No

NA

4.

Are emergency instructions and telephone numbers at telephone?

Yes

No

NA

GENERAL

5.

Is good housekeeping maintained?

Yes

No

NA

6.

Is the workplace free of trip hazards?

Yes

No

NA

7.

Are electrical cords and wires free of burns and fraying?

Yes

No

NA

8.

Are electrical outlets free of overloading?

Yes

No

NA

CLINIC FACILITIES

9.

Are lab coats and gloves worn as appropriate?

Yes

No

NA

10.

Are glasses, sharps and needles properly handled and contained?

Yes

No

NA

11.

Is eating, drinking, etc. prohibited?

Yes

No

NA

12.

Are handwash facilities available?

Yes

No

NA

13.

Are infectious, medical and hazardous wastes properly handled?

Yes

No

NA

14.

Are informational and caution signs posted and legible?

Yes

No

NA

15.

Are appropriate splash shields provided?

Yes

No

NA

16.

Is eye protection provided?

Yes

No

NA

17.

Are safety showers and eye wash stations provided where hazardous chemicals may be splashed?

Yes

No

NA

18.

Are gas cylinders secured?

Yes

No

NA

TRAINING

 19.

 Have employees received required immunization reviews?

Yes

No

NA

 20.

 Have guidelines on lifting and moving been provided?

Yes

No

NA

 21.

Has hazardous chemical training been provided?

Yes

No

NA

 22.

Have employees attended required bloodborne pathogen training within the past 12 months?

Yes

No

NA

 23.

 Are Material Safety Data Sheets (MSDS) available?

 Yes

No

NA