Sunny Oaks, Inc. Safety & Sanitation Checklist Home: Inspector: Date: This inspection is to be done monthly & a response made to each item needing attention. PLEASE CIRLE APPROPRIATE NUMBERT OF LOCATIONS, PUT N/A FOR ANY PARTS WHICH DO NOT APPLY. I. BEDROOMS LIGHT FIXTURES ADEQUATE AND COVERED CURTAINS OR WINDOW SHADES ON EACH WINDOW, WINDOWS NOT BLOCKED AND WORKING. FLOORS CLEAN AND IN GOOD REPAIR SHELVES AND WINDOW SILLS CLEAN AND IN GOOD REPAIR 20181123 Safety and Sanitation Checklist Page 1 of 8
BEDROOMS CONTINUED COVER PLATES IN PLACE & IN GOOD REPAIR BED AND LINENS IN GOOD REPAIR MATTRESS COVERS IN GOOD REPAIR DRESSERS ONE PER RESIDENT AND IN GOOD CONDITION II. CLOSETS CLEAN AND IN GOOD REPAIR, NO ACCUMULATION OF COMBUSTIBLES OFFICE AREA Light Fixtures Curtains or window shades on each window, window not blocked and working Shelves/windows/sills clean and in good repair Floors clean and in good repair, no clutter Cover plates in place & in good repair Furniture clean in good repair No cords in walking areas Exits clear No use of extension cords Page 2 of 8
III. BATHROOMS LIGHT FIXTURES ADEQUATE AND IN GOOD REPAIR MIRRORS IN GOOD REPAIR AND CLEAN HOT WATER TEMPERATURE 120 F OR LESS FLOORS CLEAN AND IN GOOD REPAIR STORAGE CLAN AND IN GOOD REPAIR BASIN, TUB, SHOWER, AND STOOL CLEAN AND FREE OF ODORS AND IN GOOD WORKING ORDER NON-SKID BATH MATS AVAILABLE (2 PER BATHROOM) SHOWER SPRAY NOZZLE CHECKED AND IN WORKING ORDER SHOWER CHAIRS CHECK TRUNK SUPPORTS, ADAPTIVE EQUIPMENT IV. STORAGE CLEAN LINENS CLEAN AND ORDERLY 1. Upstairs: 2. Downstairs: FOOD STORAGE (NON-REFRIGERATED) Kitchen: food up off the floor Pantry: food up off the floor Back hall/utility Nothing over 10# stored over head Page 3 of 8
NO CHEMICALS IN FOOD STORAGE AREAS Kitchen Pantry Back hall/utility SHELVES CLEAN Kitchen Pantry Back hall/utility FOOD STORED IN COVERED/SEALED, LABELED CONTAINERS Kitchen Pantry Back hall/utility FOOD STORAGE (COLD) Kitchen Refrigerator Exterior Clean Interior Clean Temperature 45 F or colder Orderly Storage Stored in covered/sealed, labeled containers Food over 3 days old Seal Clean Bottom grate clean FREEZER Exterior Clean Interior Clean Orderly Storage Temperature 32 F or colder CHEMICAL STORAGE Kitchen (locked) Utility Room (locked) Trays under spouts to catch drips Office CHEMICALS IN ORIGINAL CONTAINERS OR APPROPRIATELY MARKED SECONDARY CONTAINERS Kitchen (locked) Utility Room (locked) Page 4 of 8
V. KITCHEN Water temperature 140 F or colder Appliances clean and in good repair no frayed cords Stove top & burner trays Dishwasher Oven Vent hood Coffee maker Microwave Toaster Other (list what it is) Cover plates in good repair INTERIOR SHELVES AND DRAWERS CLEAN AND IN GOOD REPAIR Medical cabinet s Spice cabinet Paper storage Dish storage Utensils Pots and pans shelves UTENSILS AND DISHES CLEAN AND IN GOOD REPAIR Food prep and serving items Eating items Garbage can clean and in good repair Kitchen laundry separate from other laundry VI. VII. DINING ROOM Clean tablecloths Tables and chairs clean Floors clean Cover plates in good repair COMMON AREA Floors clean and in good repair Light fixtures covered, all bulbs (in sockets and working) Walls clean and in good repair Exits clear Stairs and hallways free of clutter Windows clean and in good repair Furniture clean and in good repair Handrails in good repair Cover plates in good repair Page 5 of 8
VIII. IX. UPSTAIRS Floors clean and in good repair Light fixtures covered, all bulbs (in sockets and working) Walls clean and in good repair Exits clear Stairs and hallways free of clutter Windows clean and in good repair Furniture clean and in good repair Handrails in good repair Cover plates in good repair FIRE PREVENTION SMOKE ALARMS Free of obstructions In good repair (if battery operated/backed up date tested) FIRE ALARM SYSTEM Tested monthly (indicate date checked) Extinguishers serviced annually, (indicate date serviced) Turn extinguisher upside down to rotate the chemical (write date on back of tag & here) Fire drills run and documented (indicate date) Proper disposal of cigarettes No combustibles near water heater No permanent extension cords Exits are not blocked Back flow system inspected annually (indicate date) EMERGENCY PLAN AND PHONE NUMBERS POSTED Staff phone Staff phone (mounted on wall and plugged in) Office phone Office phone (mounted on wall and plugged in) X. MISCELLANEOUS CLEANING EQUIPMENT Adequate In good repair WASHER AND DRYER Exterior clean Lint traps clean Outside lint catcher clean FURNACE Furnace filter clean (date last done and by whom) Page 6 of 8
FLASHLIGHTS ADEQUATE AND OPERATIVE Down stairs Upstairs XI. OUTSIDE Walkways clean and in good repair Driveway clean Fire excape clean and in good repair Bushes trimmed Lawn edged and mowed Outside lights working Patio area clean and uncluttered Cigarette butt disposal can has sand/water in it & not a fire hazard Garbage cans out of sight from the street XII. VEHICLE EXTERIOR INSPECTION Auto body checked for nicks, dents, scratches, misc. damage (Mark Damage on Diagram Below) Side view Mirrors secure, tight and clean Windows can be opened and closed Windows can be opened and closed Windshield wipers work (washer fluid full) Page 7 of 8
VEHICLE CONTINUED Windshield is clean/has no cracks or chips Doors lock and close properly Head lights (high and low beams) work Turn signals in working order Brake, reverse and tall lights work Exterior washed Inspect for leakage under vehicle (oil, radiator, transmission, brakes, etc.) Tires have tread depth greater than 3/16 (Tread bars show or use a penny, top of the Lincoln Memorial is always covered by the tread) Tires Rotated every 5,000 miles (indicate date and mileage rotated) Wheelchair carrier in good repair INTERIOR INSPECTION Van notebook, registration, insurance, documentation Horn works Seats checked for damage Seat belts secure and work Interior clean (last time vacuumed) Interior windshield clean Defroster(s) and heater(s) work (seasonal) Spare tire, jack, and lug wrench secure in vehicle Wheelchair lift and lock system in good working order SAFETY ITEMS Fire extinguisher secure and charged First aid kit (secure) Flashlight (working) Blood borne pathogen kit Person Completing Checklist: Name (printed) (Signature) Safety representative and team leader reviewed: Returned to team leader for completion of repairs and to be reviewed Page 8 of 8