Physician and medical practitioner safety checklist

Date:

Inspected by:

Location:

Bloodborne pathogens

Pass

Fail

N/A

Action required

Completion date

Is a bloodborne pathogen plan in place?

Are all employees trained on the bloodborne pathogen plan?

Is regulated waste discarded according to applicable laws and regulations?

Are medically approved first-aid kit and sharps containers adequately supplied?

Compressed gas storage

Pass

Fail

N/A

Action required

Completion date

Are cylinders legible marked to clearly identify the contents?

Are cylinders stored in areas that are protected from external heat sources?

Are cylinders located or stored in areas where they will not be damaged by passing or falling objects or tampered with by unauthorized persons?

Are cylinders stored or transported in a manner to prevent them from creating a hazard by slipping, falling or rolling?

Are valve protectors/caps in place on cylinders that are not in use?

Elevators

Pass

Fail

N/A

Action required

Completion date

Are inspection certificates up to date and available for inspection?

Do elevators provide sufficient space for moving passengers, equipment or cargo between floors?

Exam rooms

Pass

Fail

N/A

Action required

Completion date

Are warning labels properly posted for all medical equipment?

Are sufficient supplies available for safe operations? (gloves, hand washing facilities, etc.)

Hazard communications/chemical handling

Pass

Fail

N/A

Action required

Completion date

Are eyewash fountains and safety showers provided and in working order where corrosive chemicals are handled?

Are chemical containers labeled properly?

Is proper PPE available when necessary to handle chemicals?

Are flammable and toxic chemicals properly stored in closed containers when not in use?

Are chemical piping systems clearly marked as to content?

Are adequate means readily available for containing spills or overflows properly and safely?

Are hazardous substances handled only in properly designed and exhausted locations?

Is there a list of hazardous substances that are used in your workplace?

Is the written hazard communication plan up to date?

Are all Material Safety Data Sheets up to date and readily available?

Are all containers of hazardous substances labeled properly with the product identity and any applicable hazard warnings?

Is the master list of chemicals used up to date?

Housekeeping

Pass

Fail

N/A

Action required

Completion date

Is a first aid kit available and adequately stocked?

Are all exits clearly marked, unlocked and free of obstruction?

Are work areas properly illuminated?

Are caution labels and signs used to warn of hazardous substances and biohazards?

Is there safe clearance for equipment through all aisles and doorways?

Are aisles properly marked and kept clear?

Are hand trucks maintained in safe operating condition?

Are shelves secured and constructed to withstand the maximum designated storage weight?

Are shelves secured to prevent tipping or falling?

Are floors free of clutter that might cause slips, trips and falls?

Are signs used to identify slippery floors when wet or during clean-up?

Do stairs have handrails that are in good condition?

Material handling

Pass

Fail

N/A

Action required

Completion date

Do employees carry loads in excess of 50 lbs by hand?

Are mechanical means provided to carry heavy or awkward loads safely?

Are aisles and pathways clear of debris and clearly marked?

Office

Pass

Fail

N/A

Action required

Completion date

Are all aisles, passageways and doorways clean and clear of obstruction?

Are chairs, benches and other seating surfaces clean, in good condition and lacking undue signs of wear or fatigue?

Are adjustable chairs provided for employees that spend significant time seated?

Is sufficient lighting provided in all work areas?

Are monitors positioned comfortably, with employee eye level near the top of each screen?

Are cords arranged such that they do not cause a tripping hazard to employees?

Are office supplies stored such that they are easily accessible without undue employee strain?

Are floor coverings in good condition, free of slip or trip hazards?

Parking/Sidewalks

Pass

Fail

N/A

Action required

Completion date

Are paved surfaces smooth and free of large cracks or unevenness?

Are all surfaces free of ice and snow?

Are parking spaces clearly marked and sufficiently sized?

Are outdoor areas sufficiently lit at night?

Personal protective equipment

Pass

Fail

N/A

Action required

Completion date

Are protective goggles or face shields provided and worn where there is a danger of flying particles or corrosive materials?

Are approved safety glasses worn at all times in areas where there is a risk of eye injuries?

Are protective gloves, aprons, shields or other means provided where employees could be cut or where there is reasonably anticipated exposure to; corrosive liquids, chemicals, blood or other potentially dangerous materials?

Is PPE maintained in a sanitary condition and ready for use?

Are adequate work procedures and PPE provided and used when cleaning up spilled toxic or hazardous materials or liquids?

Are appropriate hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives readily available?

Recordkeeping

Pass

Fail

N/A

Action required

Completion date

Are OSHA 300/300A logs maintained?

Are employee medical and exposure records maintained as required?

Are training records maintained?

Are employee records maintained?

Are all operating permits and records up-to date?

Are current Motor Vehicle Records available for all employee drivers?

Are records kept of all safety inspections?

Are records kept of safety meetings?

Are records kept of accident investigations?

Are records kept of any emergency response drills?

Restroom

Pass

Fail

N/A

Action required

Completion date

Are toilet and sink surfaces clean?

Are adequate provision made for hand-washing (hot water, soap, towels or hand-dryers)

Are floor surfaces clean and dry?

Is a record of cleaning and resupply dates/times clearly displayed?

Stairways

Pass

Fail

N/A

Action required

Completion date

Are stairways clearly marked?

Are stairwells well lit?

Are stairwells clean and free of debris?

Are handrails secure and in good repair?

Are stairwell exit doors unlocked as appropriate?

Storage areas

Pass

Fail

N/A

Action required

Completion date

Are shelves secured and constructed to withstand the maximum designated storage weight?

Are shelves secured to prevent tipping or falling?

Waiting room

Pass

Fail

N/A

Action required

Completion date

Are all chairs, booths and other seating surfaces in good condition, without bent or broken legs or damaged seats?

Are floors clear of debris and moisture?

Is sufficient lighting provided?

Workplace postings

Pass

Fail

N/A

Action required

Completion date

Are OSHA and state required posters prominently displayed?

Are safety/warning signs properly posted where appropriate?

Are emergency phone numbers posted prominently?

Is a first aid kit available and adequately stocked?

Are emergency evacuation routes identified and prominently posted?

Radiation

Pass

Fail

N/A

Action required

Completion date

Are registration/inspection forms clearly posted near all licensed radiation sources?

Is adequate shielding provided for patients? (lead aprons, etc.)

Is adequate distance or shielding provided for employees that are potentially exposed to ionizing radiation?

Are dosimeters (badges, rings, etc) provided for employees who are likely to be exposed to significant long term doses of radiation? (> 5 mSv/year)

Are special protections in place for employees who are or may be pregnant?

Are all radiation sources tested regularly by a competent person to assure that x-rays and other types of radiation are not "leaking" outside the intended beam path?

Are employees adequately trained on the operation of radiation sources and the dangers associated with high radiation doses?

Is an emergency cut-off switch clearly labeled and readily accessible to employees working near radiation sources?