Environmental Risk Assessment Checklist

Date

Hour MinutesAM/PM Option

Inspected By

First NameLast Name

Site Location

SAFETY

Rows	Yes	No	N/A	NOTES/COMMENTS/REQUESTS
There is adequate lighting indoors and outdoors.
All lights are working inside the house.
All appliances are plugged directly into the wall
All outlets and switch faceplates are covered.
There are no frayed electrical cords.
Electrical Panel is unobstructed.
Electrical Panel is breaker labels are clearly marked.
Cords or cables are not causing trip hazards.
Are permanent use cords or cables covered by runners when crossing walkways?
Hallways are clear to allow for adequate walking?
Floors/carpets are clean and dry and slip resistant.
Floors and carpets are in good condition and free from tripping or falling hazards?
Carpeted areas are clean, secured to the floor and free of worn or frayed seams.
Wires or cables are not extending across hallways.
Staff are using "wet floor" signs as needed.
Walls and wall finishes are in good condition and free from damage.
Wiring/cables in walls and ceilings properly sealed and covered.
All ceiling tiles are in place.
All ceiling tiles are in good repair and free from damage (such as holes or water stains).
Employees are wearing ID badge.
All window and door alarms are functioning properly.
Cameras are correctly positioned are working.
Emergency lighting and walls charged lights are available in all rooms and hallways
Emergency contacts are posted
Facility license is posted
Clients Rights is posted
Joint Commission Accreditation certificate is posted.
All paper client information is secured.
EMR is not viewable to clients.
QR code scan buttons are installed and operating correctly on doors of client bedrooms.

Other

FACILITY AND GROUNDS

Rows	Yes	No	N/A	NOTES/COMMENTS/REQUESTS
Doors and locks are in good working condition.
No signs of mold.
No signs of weather damage.
Windows are clean and have screens.
Air conditioning vents are clean and unobstructed.
Washer/Dryer logs are in place.
Dryer lint trap is clean.
All sharps drawers are locked.
Grounds are free of mushroom growth.
Facility and grounds have been checked for sharp plastic, glass, pins, nails and screws that may be used for self-harm.
Facility keys are in staff possession.
Facility vans are locked.
Facility vans have transportation safety information
Facility vans have a fire extinguisher that is labeled and initialed.
Facility vans have emergency road equipment.
Facility vans have an up-to-date mileage log.
Facility vans are clean and in good repair.

Other

FIRE AND LIFE SAFETY

Rows	Yes	No	N/A	NOTES/COMMENTS/REQUESTS
All exits are clearly marked?
All hallways are clear of debris and equipment?
There are two forms of egress on all floors?
Fire Drills have been conducted this month?
All doors are free of being propped open/held/wedged open?
Hallway ceilings are in good repair?
All doorways and exits are unobstructed?
Doors can close properly.
Smoke Detectors are operable.
Fire extinguishers are clearly identified.
Fire extinguishers inspected and installed.
Extinguishers safety ties are in place.
Extinguishers are unobstructed.
AC and heating vents are free from paper or linens.
Floors are free from linens and clothes.
Portable space heaters have been inspected.
Portable space heaters are unobstructed and free from paper or linens.
Combustible materials are properly stored.
Chemicals are locked and stored properly.
All chemicals are labeled and stored properly.
Adequate supply of PPE, gloves, masks and sanitizers.
Paper towels are available in client bathrooms.
Hand washing signs are in place.
Hand washing soaps and sanitizers are available in all bathrooms.
If no fire sprinkler system, doors self-latch and close.
Fire escape ladders are available and accessible in two-story houses with one form of egress.

Other

FOOD SAFETY

Rows	Yes	No	N/A	NOTES/COMMENTS/REQUESTS
Kitchen clean and tidy?
All perishable foods are properly refrigerated?
Food pantry is locked?
There are no chemicals stored with food supplies?
Food supplies are shelved and not placed on the floor?
Kitchen and laundry rooms are separated by a door during meal preparation?
Boxes containing food supplies are not leaking?
Spices are unexpired and free from insects?
Drip trays free of oil and water?
Refrigerator temperature logs are in place and current?
All opened perishable food is bagged or in air-proof containers?
All opened perishable food are clearly labeled with storage time and date
All opened labeled perishable foods are disposed after 72 hours.
Food safety signs are posted in all kitchens and dining areas.
Dishwashertemperature logs are current and up-to-date
All dishwasher and refrigerator/freezer logs have stated proper temperature ranges.
Condiments are not expired.
Dairy products and juices are not expired.
Frozen food are not expired and free from freezer burn.
Refrigerators and freezers are clean and free from spills or leaks.
Refrigerators and freezers are clean and free from rust of worn paint.
Vent hoods and refrigerators are free of dust.
Emergency food adequate.
Water supply adequate.
Batteries not expired.
First aid kits sealed.

Other

MEDICAL

Rows	Yes	No	N/A	NOTES/COMMENTS/REQUESTS
All medications are stored and labelled properly?
All client bins contain correct medications?
Staff passing medications have received proper training and are competent.
Controlled medications are double-locked.
Medication destruction measures are available and in place.
Medical equipment logs are up-to-date
Blood pressure cuff functioning and purchase date labeled
Pulse oximeter functioning and purchase date is labeled.
Thermometer is functioning and purchase dates is labeled.
Breathalyzers are functioning and purchase date is labeled
Urine samples are properly refrigerated.
Medication refrigerators temperatures are within proper range.
Food is not stored with medications or urine.
Hazardous Waste bins are properly labled.
Sharps container is available and is less than 50% full.
OTC meds are not expired.
OTC meds in First Aid kits are not expired.

Other

Date

Signature of Inspector