Reference (e.g., standard/Act/ Verification Risk regulations, etc.) Target/ Status Person(s) Item matrix Recommendation for correction completion (C, PC, Date of follow-up responsible score action (short and/or long term) date AR) D O I based on that reference beds patient lifts wheelchairs mixers med carts slings sharps container protection against falling Comments: Equipment Manuals Reference (e.g., standard/Act/ Verification Risk regulations, etc.) Target/ Status Person(s) Item matrix Recommendation for correction completion (C, PC, Date of follow-up responsible score action (short and/or long term) date AR) D O I based on that reference carts/dolly beds patient lifts wheelchairs mixers med carts slings Comments: Department Maintenance Log Book Reference (e.g., standard/Act/ Verification Risk regulations, etc.) Target/ Status Person(s) Item matrix Recommendation for correction completion (C, PC, Date of follow-up responsible score action (short and/or long term) date AR) D O I based on that reference carts/dolly beds patient lifts wheelchairs mixers med
Item Risk matrix score Verification Reference (e.g., standard/Act/ regulations, etc.) Recommendation for correction action (short and/or long term) based on that reference Person(s) responsible Target/ completion date Status (C, PC, AR) Date of follow-up D O I beds patient lifts wheelchairs mixers med carts slings sharps container protection against falling Comments: Equipment Manuals Item Risk matrix score Verification Reference (e.g., standard/Act/ regulations, etc.) Recommendation for correction action (short and/or long term) based on that reference Person(s) responsible Target/ completion date Status (C, PC, AR) Date of follow-up D O I carts/dolly beds patient lifts wheelchairs mixers med carts slings Comments: Department Maintenance Log Book Item Risk matrix score Verification Reference (e.g., standard/Act/ regulations, etc.) Recommendation for correction action (short and/or long term) based on that reference Person(s) responsible Target/ completion date Status (C, PC, AR) Date of follow-up D O I carts/dolly beds patient lifts wheelchairs mixers med
OHC_Inspection_Checklist_Template_-_April_2015.docx