Monthly Environment of Care Rounds – Outpatient Treatment Center

This checklist includes questions to ask to assess a range of risks in the physical environment. It can be used for regular
rounds that supplement the annual environment of care risk assessment. Answers to all questions should ideally be Y for
Yes (unless they aren’t applicable).
Date of Review: Reviewer: Location:

Lighting Y N N/A If N (No), Note Changes Needed

Is there adequate lighting indoors and outdoors?
Are all lights working?
Hallways and Floors/Carpet Y N N/A If N (No), Note Changes Needed
Are hallways clear to allow safe and adequate space
for walking?
Are floors/carpets clean, dry, and slip resistant?
Are floors/carpets in good condition and free from
tripping or falling hazards (bumps, tears, and so on)?
Are any wires or cables extending across hallways?
Walls and Ceilings Y N N/A If N (No), Note Changes Needed
Are walls and wall finishes in good condition and free
from damage (such as holes or water)?
Are all wiring/cables in walls and ceilings properly
sealed and covered?
Are any electrical boxes or outlet covers in walls or
ceilings damaged or missing?
Are ceiling tiles in good condition, with no areas of
penetration and staining?
Smoking Policy Y N N/A If N (No), Note Changes Needed
Is there evidence of any violation of the smoking policy?
Identification Y N N/A If N (No), Note Changes Needed
Are all employees wearing ID badges in plain view (or
per organization policy)?
Are all contracted workers wearing ID badges in plain
view (or per organization policy)?
Access Control Y N N/A If N (No), Note Changes Needed
Are all storage areas locked to prevent client access?
Can staff explain what to do if they notice a person
who doesn’t belong in a security-sensitive area?
Worker Safety and Other Threats Y N N/A If N (No), Note Changes Needed
Can staff explain their roles in protecting patients?
Can staff explain how to protect themselves?

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Can staff explain security codes?

Can staff explain how to get help in a security

emergency?
Medication Y N N/A If N (No), Note Changes Needed
Are medication rooms locked, per organization policy?
Are any medications left unattended?
Medical Records Y N N/A If N (No), Note Changes Needed
Is all paper PHI secure?
Are electronic medical records secure?

FIRE SAFETY AND LIFE SAFETY

Means of Egress Y N N/A If N (No), Note Changes Needed
Are exit sign lights working?
Are exits clearly and correctly marked?
Are hallways clear of debris and equipment?
Are all items in hallways intended for use within 30
minutes?
Doors Y N N/A If N (No), Note Changes Needed
Are doors free of being propped/held/wedged open?
Are they clear to close (nothing obstructing)?
Do they close properly?
Fire Extinguishers Y N N/A If N (No), Note Changes Needed
Are they clearly identified?
Do they have current inspection tags?
Are extinguisher safety pins in place?
Do they have clear access, with nothing in the way?
Fire Hazards Y N N/A If N (No), Note Changes Needed
Are windows free of linens?
Are items stored at least 18 inches below a sprinkler
head?
Do portable space heaters conform to applicable local
and federal codes?

Combustible Materials Y N N/A If N (No), Note Changes Needed

Are combustible materials properly stored?
Are they properly labeled?

Are they kept in a safe, designated location?

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 HAZARDOUS MATERIALS AND WASTE
Hazardous Materials Y N N/A If N (No), Note Changes Needed
Are hazardous materials properly stored, depending
on hazards (flammable, corrosive, and so on)?
Are they properly labeled?

Are staff using correct procedures for disposal?

Safety Data Sheets (SDS) Y N N/A If N (No), Note Changes Needed

Can staff explain how to find an SDS?
Can staff describe the information contained in an
SDS?
Is there a current chemical inventory, updated within
the last 12 months?
Has staff been briefed on the “Right to Know”
requirement regarding chemicals used on the job, per
the Occupational Safety and Health Administration
(OSHA)?
Medical Waste Y N N/A If N (No), Note Changes Needed
Is medical waste in red biohazard bags or labeled
bins?
Is it properly stored and disposed of?
Is it properly separated and segregated?

Equipment Cleaning and Storage Y N N/A If N (No), Note Changes Needed

Is equipment clean and stored properly?

Can staff recognize clean and dirty equipment and
supplies (including linens) by storage methods?
UTILITIES
Utility Systems
Are the circuit boxes clearly labeled inside?
Are the water and gas shutoff valves labeled?

LOCATION SPECIFIC
Kitchen Y N N/A If N (No), Note Changes Needed
Is the refrigerator cleaned?
Is client food stored separate from staff food?
Is all client food labeled with an open and discard
date?
Are the refrigerator and freezer within acceptable
temperature range?
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Group Room #1 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ceiling fan clean?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Group Room #2 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ceiling fan clean?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #1 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #2 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #3 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ventilation fans free of dust?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #4 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ventilation fans free of dust?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #5 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ventilation fans free of dust?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Staff Office #6 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ventilation fans free of dust?
Are all sprinkler heads intact and unobstructed?

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 Surfaces wiped and free of dust?
Staff Office #7 Y N N/A If N (No), Note Changes Needed
Are all means of egress clear?
Ventilation fans free of dust?
Are all sprinkler heads intact and unobstructed?
Surfaces wiped and free of dust?
Storage Near Kitchen Y N N/A If N (No), Note Changes Needed
Are all sprinkler heads intact and unobstructed?

Test each emergency exit sign and egress light for 45 seconds each month. Check to make sure the meter on
the fire extinguisher is green, that the pin is in place, and that the hose is free of obstruction.

Fire
Y N N/A If N (No), Note Changes Needed
Extinguisher
#1
#2

#3

#4

#5

Egress Lights Y N N/A If N (No), Note Changes Needed

#1
#2
Smoke Detector Y N N/A If N (No), Note Changes Needed
#1
#2
#3
#4
#5

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