IOP Environmental Risk Assessment Checklist
Date
-
Month
-
Day
Year
Hour Minutes
AM
PM
AM/PM Option
Inspected By
First Name
Last Name
Site Location
Please Select
Skillman North
Skillman South
Skillman East
Hannan Ranch
Lohrman
Rebecca
Magnolia
Sonoma Mountain
Penngrove North
Penngrove South
Thompson
Auberry North
Auberry South
Mary
DiVinci
Bradley
320 Washington
SAFETY
Yes
No
N/A
NOTES/COMMENTS/REQUESTS
There is adequate lighting indoors and outdoors.
All lights are working inside the building.
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.
Emergency lighting and walls charged lights are available in all rooms and hallways
Emergency contacts are posted
DHCS certificate is posted
Clients Rights is posted
Joint Commission Accreditation certificate is posted.
All paper client information is secured.
EMR is not viewable to clients.
Other
FACILITY AND GROUNDS
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
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.
All sharps drawers are locked.
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.
Gas shutoff signs are posted
Water shutoffs are posted
Other
FIRE AND LIFE SAFETY
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 quarter?
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.
Hand washing signs are in place.
Hand washing soaps and sanitizers are available in all bathrooms.
Other
FOOD SAFETY
Yes
No
N/A
NOTES/COMMENTS/REQUESTS
Kitchen clean and tidy?
Food pantry is locked?
There are no chemicals stored with snacks?
Snacks are shelved and not placed on the floor?
Refrigerator temperature logs are in place and current?
All opened labeled perishable foods are disposed after 72 hours.
Other
MEDICAL
Yes
No
N/A
NOTES/COMMENTS/REQUESTS
All UA supplies are stored and labelled properly?
Staff taking UA's have received proper training and are competent.
Controlled medications, MAT 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.
Narcan station is adequately supplied.
Narcan is not expired
Other
Date
-
Month
-
Day
Year
Date
Signature of Inspector
Submit
Should be Empty: