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Facilities Check List

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CLIENT NAME:
Agent:
It is important to make notes on any and all safety hazards during your visit, however it is equally important to document those things which you see that are good as well. Our notes, good and bad, are PSA only evidence of facts. These notes will be used in the event of litigation, as well; we can make recommendations to clients regarding these facilities which in turn increase PSA value as a reliable resource center for the elderly and their families. PSA reporting system is our greatest asset and will also create consistency with not only the facilities, but our clients as well. It is critical to take immaculate detailed notes. PSA can be held accountable if we miss something and our client ends up injured or worse. These notes not only protect our client, but they also protect PSA. AGENT MUST SIGN VISITORS LOG BOOK AT FRONT DESK - THIS IS PROOF OF BEING THERE AND THE LENGTH OF TIME WE HAD TO FILL IN OUR REPORT.
FACILITY NAME:
Date
Time:
PARKING LOT:
1. Are there any safety hazards or suspicious people in the parking lot?
2. How is the visibility?
3. Can our client see clearly if in the parking lot, especially moving vehicles?
4. Is it full?
5. Are there any delivery vehicles entering the front door?
LOBBY:
1. How was access to the building?
2. Observe the visitors, staff, and residents, note any safety hazards as well as good behavior, particularly with the staff.
3. Was there someone at the front desk? If not, why? If yes, how was their behavior?
4. Were there door mats? If yes, were they slip or trip resistant?
HALL:
1. Observe any residents, visitors, and staff in the hall way. If present, make notations only if behavior is alarming or favorable.
2. Is hall free of clutter? Can resident and guest move freely through the halls? Make notation when residents are left unattended in wheel chairs if no staff are present.
3. Was there a fire extinguisher available?
CAFETERIA:
1. Is it clean?
2. Are staff present?
3. If residents eating, what is the quality and presentation of food, particularly our clients.
4. Is everyone eating the same thing?
5. Is there a clear walking area between tables, chairs, walkers, wheel chairs?
CLIENTS ROOM:
1. Is room clean?
2. Is floor clear of trip hazards?
3. Is the bed and linens clean?
4. Was there anyone visiting or in the room? If yes who and why?
5. Was the PSA Certificate of Protection on the wall or bedside table? Was it visible? VERY IMPORTANT!!!
6. What is the condition of the furniture in the room? Who maintains it?
7. Were all the lights working?
BATHROOM:
1. Is floor free of trip or slip hazards?
2. Are all the lights working?
3. Are all the fixtures working?
4. Were all of the linens clean and available?
5. Was the bathroom free of hazards?
6. Check the water temp and make sure not to hot/cold.
7. Where are medications kept? Who dispenses them?
SECURITY:
1. Was there a security person(s) on duty?
2. Check security monitors, are they working?
3. Are security doors locked and working?
4. Is security gate locked and working?
Be as efficient as possible and make sure you check in with the shift manager either before or after your check list report. If necessary, inform manager of any concerns or hazards you noted. Also congratulate the manager on the things you noted as good.
WEATHER:
1. Temperature
2. Forecast
Additional Comments:
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