KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

MINISTRY OF HEALTH ‫وزارة الصحة‬

OQLA AL-SOQOUR HOSPITAL ‫مستشفى عقلة الصقور‬
Scope of risk (Life Safety) Checklist
WARD/UNIT: _____________________ DATE: ____________________
LEGEND: PT = Preparation Tool INT = Interview OBS = Observation MR = Medical Record O/I = Observation/Interview DR=Document
Review NM =Not met (Score = 0 when < 50 % compliance) PM = Partially met (Score=1 ≥ 50 to < 80 % compliance) FM = Fully met( Score= 2 when
≥ 80 % compliance) NA = Not applicable(Cancelled Score )
RESULT
Points of measurement PT COMMENTS

NM PM FM NA
0 1 2
SAFETY OBS
1. Physical environment is free of hazards to patients, staff and visitors.

2. Hazard surveillance programs are ongoing and involve detection of safety hazards DR
and unsafe practices.

3. Periodic evaluations are conducted for the impact of buildings, grounds, equipment DR
and internal physical systems.

4. Abiding to the policies and procedures in O/I

 Identification of infants.
5. All fire alarms, audible signals and alarms are in appropriate condition. OBS

6. Wet floor sign boards, ropes and cones are used by housekeeping staff whenever OBS
floors are wet mopped.

7. Oxygen pressure in cylinders are checked and logged daily. DR

8. To control and minimize the hazards of fire, explosions and electricity the following DR
are monitored on regular basis:-
 Electrical systems.
 Gas and vacuum systems.
 Ventilation systems.

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 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
MINISTRY OF HEALTH ‫وزارة الصحة‬
OQLA AL-SOQOUR HOSPITAL ‫مستشفى عقلة الصقور‬
Scope of risk (Life Safety) Checklist
Flammable and combustible materials.
Electrical equipment.
Gas equipment.
 Laboratories (general Lab. and dental lab.)
9. Compressed gas cylinders are; OBS
 Stored upright.
 Labeled.
 Have valve protection caps on until placed in use.
 Chained/strapped and secured.
OBS
10. Storage areas are well ventilated.
11. All flammable liquids are labeled. OBS
12. Safety/Life safety related information is used in orientation of new hires. DR
13. Smoking policy and regulations are abided by all employees, patients and visitors. DR
14. Hazardous materials and wastes are procured, identified, stored, used and O/I
disposed according to the hospital policy and procedures.

15. Anesthesia areas are monitored for exposure levels. O/I

16. Scavenging systems or adequate air exchange rates are in place. OBS

17. Hazardous materials and wastes are labeled. OBS

18. Hazardous waste storage and processing areas are separated from patient care, O/I
food preparation and food serving areas.

NAME&SIGNATURE OF ASSESSOR:__________________________ NAME&SIGNATURE OF HEAD DEPART:_____________________

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