UNC CHAPEL HILL SAFETY INSPECTION CHECKLIST
CLINIC ENVIRONMENT

WORK UNIT: ________________________________________ SUPERVISOR: ________________

DEPARTMENT: ___________________ BLDG: _________________ ROOM #(s): ____________

During the inspection of the designated area, circle the correct answer at the end of each question. If the question does not apply, circle (NA).

BASIC LIFE SAFETY Finding (circle one)
1.      Is the Fire Emergency plan posted? Yes No NA
2. Are corridors and exits free from obstruction? Yes No NA
3. Are exit signs illuminated and visible? Yes No NA
4. Are emergency instructions and telephone numbers posted next to telephone? Yes No NA
GENERAL
5. Is good housekeeping maintained? Yes No NA
6. Is the workplace free of trip hazards? Yes No NA
7. Are electrical cords and wires free of burns and fraying? Yes No NA
8. Are electrical outlets free of overloading? Yes No NA
CLINIC FACILITIES
9. Are lab coats and gloves worn as appropriate? Yes No NA
10. Are glass, sharps and needles properly handled and contained? Yes No NA
11. Is eating, drinking, etc. prohibited? Yes No NA
12. Are handwash facilities available? Yes No NA
13. Are infectious, medical and hazardous wastes properly handled? Yes No NA
14. Are informational and caution signs posted and legible? Yes No NA
15. Are appropriate splash shields provided? Yes No NA
16. Is eye protection provided? Yes No NA
17. Are safety showers and eye wash stations provided where hazardous chemicals may be splashed? Yes No NA
18. Are gas cylinders secured? Yes No NA
TRAINING
19. Have employees received required immunization reviews? Yes No NA
20. Have guidelines on lifting and moving been provided? Yes No NA
21. Has hazardous chemical training been provided? Yes No NA
22. Have employees attended required bloodborne pathogen training within the past 12 months? Yes No NA
23. Are Material Safety Data Sheets (MSDS) available? Yes No NA

COMMENTS:_______________________________________________________________________

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INSPECTOR:_______________________________________________ DATE:_________________