TJC Environment of Care Survey Tool for the Hospital 2011
Area: Date: Manager: COD:
# Question M NM NA # Question M NM NA
The organization manages safety and security risk. The organization manages risks associated with its
EC.02.01.01 utility systems. EC.02.03.05
Employees wear their photo ID There is 36 inches clearance in all
badges above the waist. planes in front of electrical panels.
In high security areas, security Electrical panels in public access
measures are in place. areas are closed & locked.
The organization manages risks related to Panels are labeled and have no
hazardous materials and wastes. EC.02.02.01 open slots.
Food /drinks are not found in areas Medical gas shut offs are correctly
3 with chemicals or blood or body 24 labeled and the rooms they serve
Chemicals are labeled correctly. The organization establishes and maintains
(including EVS chemicals) a safe, functional environment. EC.02.06.01
In areas that perform HLD or labs,
Supplies are stored off the floor to
5 eyewashes are available, installed 25
correctly and checked weekly.
The blue pharmacy waste bins are
6 26 There are no trip or slip hazards.
being used correctly.
Regulated medical wastes are Nursing pull cords are functional
disposed of properly. and operational.
Needle boxes are secured and not In pediatric areas, EVS rooms are
Refrigerators that contain blood or
Observations show protection of
9 body fluids are labeled with a 29
patient confidentiality and privacy.
All transport containers of blood,
body fluids or pathological
10 30 Medications are secured.
specimens are labeled with
All areas in clinic or unit are clean
11 Oxygen cylinders are secured. 31
Areas where oxygen cylinders are
12 stored are correctly labeled, “full/in- Soiled Utility Rooms
use”, and/or “empty/return”.
Laundry and trash chutes are
The organization manages fire risks EC.02.03.01 32
closed and locked.
Fire extinguishers and pull stations
13 33 Soiled utility rooms are clean.
are not blocked.
14 RACE cards are posted. 34 Soiled utility rooms are uncluttered.
Means of egress for the area are The organization has an Emergency Management
unobstructed. Plan EM.02.01.01
Means of egress are clearly and Emergency Response Guides are
correctly marked. posted.
17 Exit doors are not blocked. 36 Bathrooms keys are available.
Doorways to main egress corridors The organization manages medical equipment risks
are not propped or tied open. EC.02.03.03
Items are at least 18 inches from the All clinical equipment has current
ceiling in sprinkled areas. and readable PM tags.
Combustibles are not stored next to
Can staff articulate correct answers to the following questions?
# Question M NM NA # Question M NM NA
Where would you find the
The organization has an Emergency Management Plan Bloodborne Pathogens Exposure
52 Control Plan on-line? TB ECP?
Where is the unit’s site specific Fire How would you manage a known
37 53 or suspected TB patient?
Plan? Are Parts I and II present?
In pediatric areas, what steps are Who would you call for suspected
38 taken to prevent missing or abducted 54 TB exposures?
What type of respiratory equipment
What would be your response to a is worn by employees for TB
Code Pink? isolation patients?
What steps would you take if you Where would you find the Material
40 witnessed suspicious activity, or 56 Safety Data Sheets for chemicals
violent behavior? or medications used in your area?
Do you work with hazardous
What is Code Red, Orange, Black, drugs? (e.g. chemo) If so, can you
Triage? locate the Hazardous Drug Policy
Do you have hazardous chemical
42 What does RACE mean? 58 or drug in your area? If so, how do
you handle a spill.
Do you perform High Level
43 What does PASS mean? 59 Disinfection? If so, what
precautions would you take?
Where are the nearest fire How would you report an unsafe
44 extinguishers and pull stations? 60 condition, or a staff, patient or
Where would you move to in the What steps are taken to prevent
45 event of a fire? 61 the inappropriate reuse of
What is the fire code for your
location? Or where can you locate it The organization manages risks associated with its
quickly (building, floor, zone)? utility systems. EC.02.03.05
What is Hospital Incident Command Where are the cut off valves for
47 System? 62
The organization manages risks related to hazardous What would you do in the event of
materials and wastes. EC.02.02.01 a power failure?
Management: Can you provide your
The organization manages medical equipment risks
48 Safety training and EOHW
compliance data? EC.02.03.03
Management: What are the actual What steps would you take if a
49 compliance rates for the area? Are 64 piece of medical equipment fails or
they above 90%? malfunctions while in use?
What safety devices to prevent
50 accidental needlesticks are in your Other
unit? How do you use them?
What number do you call if you had
51 blood or body fluid exposure? 65 Other issues?