EOC Rounding Tool
Entity
Please Select
FWMC
Rehab Rockville
Rehab WOMC
SGMC
WOMC
BH 14901/907/915
Input Finding
Finding
Please Select
Misc Ceiling Tile Issues
Blocked Fire Extinguisher
Daisy Chain Power Strip
Corridor Obstruction
Fire Door Latching
Oxygen Tank Storage
Sharps Container Full
Expired Supplies
Expired Medications
High Dust Dirty Vents
Exit Sign Out
Blocked Fire Panel Shut-off
Med Gas Shutoff Blocked
Hazardous Waste Labeling
HVA Awareness
EOP Accessibility
Redundant Comms (PTT)
96-Hour Sustainability
Eyewash Station Flush
Damaged Wall Sheetrock
Interior Space; walls, peeling paint, drywall (Safety)
Refrigerator Temps
Exposed Wiring
Sharps Container Full
Unlabeled Fridge Food
Eyewash Station Access
Exposed Wiring
Egress Lighting Out
Medication Fridge Temp
Sprinkler Clearance - Storage 18-Inch
Sprinkler Heads Require Cleaning
Negative Pressure Failure
Critical Space Air Flow & Pressure
Unsecured Meds Cart
Broken Handrail Floor
Utility Closet Storage
Staff Role (HICS)
Spill Kit Location
Red Plug Utilization
Blocked Electrical Panels
Improper Storage in Clean Holding
Cardboard/Inappropriate Storage
Fire Barrier Integrity
Exit Access Obstructions (Blocked)
Smoke & Fire Door Closures
Substandard Environmental Cleanliness
Missing Sprinkler Escutcheons
Trash/Waste Greater Than 32 Gallons
Blow out Patch on Fire/Smoke Barrier
Blocked Manual Fire Alarm Pull Station
Fire Extinguisher Inspection (Monthly) Not Signed Off
Lights Out or Non-Functional
Egress Pathway/Corridors/Stairwells
Floor tiles are clean and in good repair
Sensitive Areas Secured (Servers Rms/Clean Holding)
Chemicals Not Correctly Labeled
Med Gas Panel Blocked or Limited Access
Work Station Open and Unattended - Security Access Risk
Vendor or Staff Not Wearing Proper ID Badge
High Touch Surfaces Require Cleaning
Open Food/Drink Container in Nurse's Station
Pressure Monitor Not Visible - If Applicable
Refrigerators - Temp Logs Not Up to Date
Air Pressurization Issue
Update Life Safety Drawings
Misc Mechanical Devices Malfunctioning/Broken (HVAC/Utilities)
Hot Water Temp Failure (Water Manage Plan/IP)
Standard
EP
CMS_Tag
Rounding_Requirement
Notes
Photo of Finding
SGMC Main Hospital (Original)
1st Floor
2nd Floor
3rd Floor
4th Floor
Non-Patient Care Areas
Room/Office Number
Horizon Tower
Horizon - 1st Floor
Horizon - 2nd Floor
Horizon - 3rd Floor
Horizon - 4th Floor
Horizon - 5th Floor
Horizon - 6th Floor
Horizon - 7th Floor
Department/Unit
Please Select
ICU
CCU
ED
Peds ED
OR
SPD
PACU
Pre-Op
Cath Lab
CVIR
Floor Unit (Specify in Notes)
Imaging
Lab
Food Svcs Area
Materials Mgmt/Loading Dock
Other
Behavioral Health (14901/907/915)
BH Units - All Bldgs
Submission
Manager Name
Manager Email Address
example@example.com
ISLM Required?
Yes
No
Actions Required By Department
Person Completing Form
Facilities_Trigger
Submit
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