Lakemary Center Safety Inspection
Completed Quarterly
Name
*
First Name
Last Name
Building/ Area
*
Please Select
Administration
School
Brotherton
Clemens
Craig Center
Mesa
Prairie
Adult Services Building
Training Center
Value Activities III
House 4
306
308
1121
1123
Ursa
Downing
Greenwood
Hartley
Careers and More/Production VA
Lifestyles I
Lifestyles II
Lifestyles III
Olathe Valued Activities
Keeler Suite A
Keeler Suite B
Keeler Suite C
Keeler Suite D
Keeler Suite E
Keeler Suite F
Keeler Suite G
Mahaffie
671
675
Sunset
Year
*
Quarter
*
Please Select
1st Quarter (Jan, Feb, Mar)
2nd Quarter (Apr, May, Jun)
3rd Quarter (Jul, Aug, Sept)
4th Quarter (Oct, Nov, Dec)
Shift
*
Please Select
Day
Evening
Overnight
All Extinguishers have been inspected monthly, are properly marked, and accessible:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All Smoke Detectors, fire alarm pull stations and the fire alarm system are tested and working properly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect).
Appropriate lighting in all rooms:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect).
Emergency lighting tested and functional:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All Emergency Exits are marked, clear of debris, and accessible:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All Windows are accessible for emergency evacuations:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Electrical Cords and all outlets are free of overload, damage, and hazard:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All telephone and cable jacks work and are mounted correctly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Emergency numbers, including poison control, fire and police department, are posted near all telephones:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All electrical outlets have ground fault interrupter circuits:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Current emergency evacuation plan and diagram are posted in each room:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Fire Drills are practiced and documented monthly:
Please Select
Yes
No
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Tornado drills are practiced and documented monthly during the months of April through September:
Please Select
Yes
No
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Carpeting is secure and includes non-slip backing
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
There is a clear path to the electrical breaker boxes:
Please Select
Yes
No
Not Applicable
Comments
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All unused electrical outlets are properly guarded in required areas:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
No clutter or debris in building, closets, corridors or aisles:
Please Select
Yes
No
Not Applicable
Comments
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Aisles are adequate size:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Stairwell is clear and stair step treads are in good condition:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Recreation equipment is appropriate and safe:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Supplies are securely stored:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All Closets are securely locked:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Trash is emptied regularly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All room floors are clear of spills:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Outside walkways are clear and in good repair:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Automobiles are locked and keys are removed:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Stove, vent fan, and exhaust hood are clean and working properly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
No flammable items are stored near or above the stove:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All refrigerators are clean and working properly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Pots and pans have securely fastened handles:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All appliance vents are clean:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Dishwasher is clean and working properly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All heating appliances are clean and working properly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Flammable liquids are stored properly
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Hot water temperature is less than 120 degrees Fahrenheit
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All showers and bathtubs are clean and have appropriate non-skid surface:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All toilet seats are in good condition, clean, appropriate heights, and secure:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All sinks are anchored securely:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All bath mats and rugs are clean and have appropriate non-slip backing:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Poisons and hazardous inedible items are not accessible to persons served:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Food is removed from all bedrooms:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Nightlights are operational:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Personal items are stored neatly:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Furniture is appropriate and in good repair:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All Tables have rounded edges:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Wall hangings and pictures are secure:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All portable fans are supervised when in use and unplugged when not in use (fans are not allowed in education or persons served residence)
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
There is appropriate fire and safety equipment which is in good repair and is kept on site and readily accessible:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
There are not any combustible or flammable materials kept in an unfsafe location:
Please Select
True
False
If False Explain:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
The site is kept clean and well maintained:
Please Select
Yes
No
Not Applicable
Comments:
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
The site is kept safe and secure:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
All furniture and equipment is in good repair and working order:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
A comfortable temperature with adequate ventilation is maintained:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
There is adequate Lighting:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
The site is free of insect and rodent infestation:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Main routes of travel are kept free of obstacles and stored materials:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
There are appropriate assistive devices and any necessary structural modifications so that the facility meets the needs of persons with physical disabilities:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Facility is sufficiently sized to meet the living space needs of the person or persons residing there as well as the additional space needs of staff working within the premises, specifically including appropriate space or spaces for : meal preparation; dining; sleeping; bathing, toileting and hand washing; recreation and day living; storage of personal items; and meeting the needs of each person being served consistent with the preferred lifestyle of the person or persons:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Emergency Kits have been checked to ensure contents are working and not expired:
Please Select
True
False
If False, Explain.
Please Include what you have done in attempts to remedy any issue.( removed clutter, placed Maintenance order, ect)
Additional Recommendations (include the number from above)
Follow up comments from previous quarter's inspection
Submit
Should be Empty: