SAFETY ADMINISTRATION

Environmental Rounds Checklist

MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
A. SAFETY MANAGEMENT
1. Can staff state/locate the Safety Manual?

2. Do all staff know how to report a patient, visitor, employee injury

or near – miss and can properly fill out (OVAR) Occurrence
Variance Accident Report form?

3. Are work areas and stairwells acceptably illuminated or

adequately lit?

4. Are fall reduction measures are in place

(Handrails secure, non-slip floor, hallway free of clutter and
obstructions to avoid tripping or injuries)?

5. Are signage readable and intact and not obstructed from sight?

6. Is the area free from signs of smoking?

7. Are patient bathrooms equipped with working nurse call system?

8. Are patient bathrooms with clearly posted directions for use of

the nurse call (English/Arabic)?

9. Can patient bathrooms be opened in an emergency (punch lock

or key, staff know location and/or procedure)?
10. Are stairwells free from obstructions and stored materials, boxes
and/or trolleys?

11. Other observations / recommendations.

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
B. LIFE / FIRE SAFETY
1. Are walls, doors, floors, ceilings of smoke compartments free of
holes?
2. Are fire extinguishers present, accessible with inspection tag,
signage and are regularly inspected.
3. Are fire hose present, nozzle in place and are regularly
inspected?
4. Are Fire alarm, pull stations clearly identified accessible and
unobstructed?
5. Are Emergency Exits not locked, blocked nor held open with
door stopper, tape or other materials?
6. Are all fire / smoke barrier doors unblocked, self-closing and
latching?
7. Is storage 20 inches (50 cm) from sprinkler heads and
protruding lighting fixtures or piping; or 24 inches (60 cm) from
the ceiling in non-sprinkled areas; 4 inches (10 cm) from the
floor and 2 inches (5 cm) away from the wall?
8. Are hallways clear of clutter, clear access (ingress/egress)?
9. Are evacuation maps current, accurate and clearly posted?
10. Are emergency exit lights in working order?
11. Can staff answer the following questions correctly:
a. What is the procedure in an event of a fire?
b. What is the acronym for the fire procedure?
c. When was the last time you participated in a fire drill?
d. How do you use the fire extinguisher?
e. How do you use the fire blanket?
f. Can you explain or demonstrate RACE and PASS?
12. Are units free from signs of smoking
(Cigarette remains and smell of cigarette smoke)?

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
C. SECURITY MANAGEMENT
1. Are female wards secured? Is there appropriate security
provided to prevent unauthorized access to remote or sensitive
areas? Refer below for the complete list.
2. Are door knobs/handles functioning properly in all rooms?

3. Are staff lockers secure?

3.1. Are patient’s valuables secure?

4. All staff in the unit are identified by appropriate ID badges

(above waist and left chest) and all persons present in the unit
wear proper identification?
5. Are staff aware of their roles and the numbers to dial in
case of the following Security-related emergency codes?

5.1 CODE WHITE (Bomb Threat / Terrorist Attack)

5.2 CODE PINK (Child Abduction / Mission)

5.3 MR. STRONG (Aggressive Person)

6. Other observations / recommendations

SPECIAL / SENSITIVE AREAS UNDER SECURITY MANAGEMENT

- All Female Wards
General Hospital - Emergency Department, 200 OR, 300 OR, PACU, MICU, Burn ICU – 300A, CCU, ICU’s (T1A1, T1A2, T1B1, T1B2) 400 H, EEG
Maternity Hospital - Emergency Department, OR, MICU, LRDR, Nursery
Pediatric Hospital - Emergency Department, PICU, NICU, RCU, SCU
- King Fahad Kidney Center (KFKC), OR in King Saud Dental Center (KSDC), CSSD, Pharmacy and Narcotic Vault, Medical Record,
- Medical Equipment Room; Construction, renovation, or demolition projects; Hospital roof; Goods store; Equipment Room

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION

INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP

D. HAZARDOUS MATERIALS & WASTE MANAGEMENT

1. Are hazardous materials properly stored
(compatibility, secured, secondary containment)?
2. Is appropriate space and/or storage provided for hazardous
materials?
3. Are hazardous materials – cleaning fluids, chemicals,
substances- appropriately labelled (name, hazard,
manufacturer, open date, expiry date, beyond use date or
discard date before expiration date (if necessary)?
4. Do pharmaceutical waste containers have only residual
medication and no needles?
5. Is chemical spill kit available / accessible (as applicable)?
6. Are Safety Data Sheet (SDS) manual and Hazardous Material
Inventory List & HazMat List up-to-date?
7. Do staff know and can locate Safety Data Sheets and the
HazMat List? (check10% of staff)

8. Are PPE supplies present? Do staff use appropriate Personal

Protective Equipment and remove when not needed?

9. Are the staff aware how to respond to a hazmat spill and

activate the CODE ORANGE?

10. Are hazardous waste properly stored, handled and disposed?

11. Are the staff aware of the procedure for regulated medical waste
(ex. Radioactive, biological) being disposed of appropriately,
according to Infection Control Policies?
12. Other observations / recommendations.

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
E. DISASTER PREPAREDNESS AND EMERGENCY MANAGEMENT
1. Does the department/unit have supply of flashlight and
batteries and in working order?
2. Are the staff aware of their roles and numbers to dial in the following hospital emergencies:
2.1 CODE RED
(Internal Disaster/ Fire/ Explosion/ Building Collapsed)
2.2 CODE YELLOW (External Disaster)
2.3 CODE ORANGE (Hazardous Material / Chemical Spill)
2.4 CODE GREEN (All clear / end of disaster)
3. Are the staff aware of their roles and the numbers to dial in case
of the following Medical-related emergency codes?
3.1 CODE BLUE (Cardiac Arrest/Code Blue Team Needed)
3.2 CODE BLACK (Rapid Response Team Needed)
4. Are the staff aware of the assembly points in their area in case
of Horizontal, Vertical and General Evacuation?
5. Are the staff aware of the location of the hospital disaster plan?
6. Are the staff aware of the location of the Incident Command
Center in a disaster?
7. Can staff hear the announcement from the overhead paging
system in their area?

8. Are directional signs sufficient and available in the unit to guide

staff, patients and visitors of the nearest emergency exit?
9. Are appropriate emergency exit doors installed and not
locked?
10. Are the staff aware of the evacuation plan and aware of the
location of the holding area in case of a General Evacuation?

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
F. MEDICAL TECHNOLOGY (BIOMEDICAL EQUIPMENT) MANAGEMENT
1. Are electrical equipment properly grounded, with cords that are
in good condition (not frayed, split or broken)?

2. Are PPM stickers present and within inspection date and staff
can answer: “How do you know if a piece of medical equipment
is overdue for Periodic Preventative Maintenance?

3. Are the staff aware of the process of removing equipment and

initiating repair requests when necessary?

4. Are laser logbooks, laser signs and laser protective equipment

available for each type or laser utilized as applicable?

5. Is the defibrillator plugged into an emergency outlet?

6. Are ventilator/s plugged into an emergency outlet?

7. Is the medical refrigerator plugged into an emergency outlet?

8. Do staff know how to check defibrillator

(and can verbalize a check with plug in and plug out from the
wall outlet)?
9. Are correct defibrillator pads available and within expiration
date?

10. Does the crash cart/defibrillator have a log compliance?

11. Does the medical refrigerator have temperature monitoring?

12. Other observations / recommendations :
Test 2-3 pieces of equipment to ensure alarms activate and are
audible.

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
G. UTILITIES MANAGEMENT
1. Are all light bulbs functioning?
2. Are compressed gas cylinders restrained with holders and/or
chains, properly stored and labelled?
3. Are all electrical plugs and cords properly secured?

4. Is the unit is free from substandard extension cords, cheater

plugs, frayed wirings and other electrical defect?
5. Are all physical structures properly maintained:
a. Walls - paint properly maintained
b. Floors – no cracks / no holes
c. Ceiling - ceiling tiles in place / intact / free of stain
d. Lights have cover guards (as applicable)
e. The switch of Emergency Lights have cover guards
f. Other structures, please specify:
6. Are medical gas shutoffs, properly identified and labelled? Do
Staff know the location of emergency shutoff valve and when
to disable it?
7. Are electrical / mechanical rooms locked and secured?

8. Are air diffusers free of dust?

9. In case of utilities failure, do staff know what number to call

and how to relay the information properly?

10. Other observations / recommendations:

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
FINDINGS /
INDICATOR MEASURES PASS FAIL NOT APPLICABLE PDCA-ACTION / FOLLOW-UP
COMMENTS

H. INFECTION CONTROL
1. Can staff state location of Infection Control Manual?

2. Are Sharps containers mounted at correct height (4-4.5ft) and

are not more than ¾ full and functional?

3. Are sharps items stored properly and are not accessible to

public?
4. Can staff state correctly, the procedure to follow in the event of
an occupational injury or body fluid exposure?

5. Are isolation signage used appropriately?

6. Are Specimens placed in bio-hazard containers when

transporting?

7. Are appropriate PPEs used when transporting specimen?

8. Are PPE supplies available and are properly used?

9. Are patient care areas free of food/drinks?

10. Are alcohol gel dispensers in place and are promptly refilled
when necessary?

11. Are sterile supplies appropriately dated and not expired?

12. Are furniture upholstered in water resistant material?

Other observations / recommendations:

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
FINDINGS /
INDICATOR MEASURES PASS FAIL NOT APPLICABLE PDCA-ACTION / FOLLOW-UP
COMMENTS

GENERAL SAFETY / ENVIRONMENT / INFECTION CONTROL

I. ENVIRONMENTAL HEALTH &SAFETY

1. Housekeeping

1.1 Are appropriate disinfectants being used?

1.2 Are staff aware of disinfectants’ contact/dwell time and is

correctly observed?

1.3 Are Housekeeping signs provided and are properly used?

1.4 Are High and horizontal surfaces clean and free from
unnecessary objects?
1.5 Are cleaning supplies not left unattended?

1.6 Is the ice machine clean?

1.7 Is the housekeeping closet room door, closed?

1.8 Is the clean utility room utilized appropriately?

1.9 Is the dirty utility room utilized appropriately?

1.10 Is everything stored at least 4 inches / 10cm off from the
floor? (A minimum of 10 cm is left to manage in case of
spills.)
1.11 Is patient care area, equipment, furniture generally clean?

1.12 Is there an evident insect or rodent control program?

1.13 Are waste properly segregated and disposed?

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
INDICATOR MEASURES PASS FAIL NOT APPLICABLE FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP

ENVIRONMENTAL HEALTH & SAFETY (CONTINUED)

2. Refrigerators

2.1. Is temperature recorded on medication refrigerator daily?

2.2. Is temperature recorded on patient food refrigerator?

2.3. Are there no food stored in medication refrigerator?
2.4. Is the employee lounge refrigerator clean?
3. Linen
3.1. Is the Linen cart covered?
3.2. Are dirty linens properly segregated?
3.3. Are there no linen bags placed on the floor at any time?
3.4. Are hampers not overfilled?
3.5. Are linen cart covers free from any items on top?
4. Medications
4.1. Are medication cupboard / rooms locked and secured?
4.2. Are narcotic cupboards/room/vault locked?
4.3. Are bedsides free from medications?
5. Sinks

5.1. Are areas under the sink free from any materials or supplies?

5.2. Is there sink for hand washing?

5.3. Are hand washing sinks free from obstruction?
5.4. Is there a supply of hand washing soap in the sink?

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
NOT
INDICATOR MEASURES PASS FAIL FINDINGS / COMMENTS PDCA-ACTION / FOLLOW-UP
APPLICABLE

ENVIRONMENTAL HEALTH & SAFETY (CONTINUED)

6. Pediatric Areas and if there are pediatric patients and visiting children from time to time

6.1. Are staff aware on how to clean toys?

6.2. Are areas of children’s reach free from medications?

6.3. Do staff request identification from people they do not

know, who are in the patient care area?

6.4. Are staff aware of the CODE PINK Policy and know when
or how to activate it?

6.5. Is the unit safe for children

(no sharp edges, electrical outlets cover, etc.)?

6.6. Other observations / recommendations

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 SAFETY ADMINISTRATION
Environmental Rounds Checklist
MULTIDISCIPLINARY AND QUARTERLY SELF INSPECTION
Members of the Environmental Safety and Disaster Management Committee and Safety Liaison Officer

NO. NAME DESIGNATION / DEPARTMENT SIGNATURE DATE

1. Safety Liaison Officer (SLO)

Chairman of Environmental Safety and

2. ENGR. SHUJAA AL JUHAIF
Disaster Management Committee

3. ENGR. MOHAMMAD SAAD AL SULTAN Director of Safety Administration

Acting Director of Prevention & Control of Infection

4. DR. HAIFA S. ALKHELEDAN
Administration

5. MR. IBRAHIM AL ZAGHIBI Director of Security Administration

6. ENGR. ABDULMONAM AL HABBABI Director of Biomedical Engineering Administration

7. ENGR. SAEED ALDAMKH Director of General Maintenance Administration

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