Slip Trip Fall Prevention Program. A Program Development Guide

Transcription

1 Slip Trip Fall Prevention Program A Program Development Guide

2 A L P H A F U N D L O S S P R E V E N T I O N S E R V I C E S Slip Trip Fall Prevention Program Guide ALPHA Fund PO Box Roseville, CA Phone Fax

3 Table of Contents SECTION 1 INTRODUCTION Policy Statement SECTION 2 SLIP, TRIP, & FALL PREVENTION PROGRAM Scope and Purpose Roles & Responsibilities References Evaluations Training Review SECTION 3 SUPPORT MATERIALS Post Incidence Response Plan Walking and Working Surface Self-inspection Check Lists Safety Rules Housekeeping Standards Seasonal Issues Corrective Maintenance Procedure Footwear Policy SECTION 4 TRAINING & AWARENESS RESOURCES Training Videos: ALPHA Lending Library Slips, Trips, Falls: Avoiding Injuries in Your Workplace Fall Prevention for General Industry Preventing Patient Falls in Hospitals Awareness Posters Don t Let Safety Slide While Walking to Your Ride Proper Training Helps Everyone Work Safely Slipping Hazards in the Workplace Are Common

4 Slip, Trip, Fall Prevention Policy Policy Statement It is the policy of (Your Facility) to provide our employees and customers safe and healthful conditions in which they can conduct business. We will strive to maintain a facility that is free from identified slip, trip and fall hazards. We have implemented a prevention program that considers the behaviors of people, our equipment, our work methods, processes and finally the environment to reduce and prevent slip, trip and fall accidents. Employees are expected to adhere to the policies and procedures outlined in the document. 1 P a g e

5 Slip, Trip, Fall Prevention Program Scope and Purpose Within the ALPHA Fund pool, falls are the second leading cause of workplace injuries. This program is designed to reduce exposure of employees to slip, trip and fall (STF) accidents. It applies to all employees of (Your Facility) in an effort to prevent these through a three-pronged intervention approach through: Education of staff and assessment of the workplace environment for hazard and controls related to STF. Performing periodic self-inspections of all workplace walking and working surfaces and taking necessary corrective action to prevent or minimize risk of injury from STF Promote appropriate response to employee reports of exposure and/or injury from slip, trip, fall hazards Roles and Responsibilities Slip, Trip, Fall Prevention Program Manager: Name & Title This person is responsible for: Ensuring that timely and professional assessments of workplace walking and working surfaces are completed. Making recommendations to correct STF fall hazards. Provide training and education to staff on methods to prevent STF fall injury. Assisting in the investigation of STF injuries and review historical injury performance. Annually reviewing and updating this STF Prevention Program for effectiveness. Communicating findings & recommendations to supervisors (and HR when injury-related). Supervisors Responsibilities: Assuring the policies and procedures are adhered to by all employees Ensuring all newly hired employees receive initial STF training prior to beginning work Observe the employees as they work. Promptly correct any unsafe behavior. 1 P a g e

6 Performing daily walk-around safety-checks of the work area and promptly correcting any hazards found. Setting a good example for employees by following safety rules and attending required training. Investigate all incidents in your area and report your findings to management. Talk to management about changes to work practices or equipment that will improve employee safety. Employees Responsibilities: Clean up spills and pick up debris to help ensure others are not injured on facility property Report hazards to supervisors or managers promptly for corrective action. Follow safety rules, safety standards and training you receive as described in this program Report all injuries and near miss incidents to your supervisor promptly regardless of how serious. Make suggestions to your supervisor or management about changes you believe will improve employee safety. Encourage peers to adhere to policies and procedures when improper behavior is witnessed. References (Cal/OSHA) California Code of Regulations Title 8, Section 3203 Injury and Illness Prevention Program and Section 3273 Working Area) Worksite Walking and Working Surface Evaluations The STF Prevention Program Manager will manage the completion of timely and professional assessments of workplace walking and working surfaces aimed at identifying and controlling STF risk factors that could result in injury. An assessment will be performed: Annually, when a change in operations or conditions exist, and periodically at the direction of the program manager. Using appropriate checklist to ensure the assessment is comprehensive for purpose (facility, department, or patient residence). When an official report of injury is made by an employee. Routine checks to be performed on time-permitted basis in response to matter(s) above. Each assessment will be documented and maintained with the Injury & Illness Prevention Program records. 2 P a g e

7 Training As an essential part of the STF Prevention Program management believes that employee involvement in the site s safety and health program can only be successful when everyone on the site receives sufficient training to understand what their safety responsibilities and opportunities are, and how to fulfill them. Therefore, training is a high priority to help ensure a safe workplace. All employees will receive awareness training during orientation. Employees who conduct formal workplace inspections will be trained on their responsibilities and on how to perform them. It includes: TRAINING WHO MUST ATTEND Slip, trip, and fall hazard awareness for all employees Workplace inspections Accident response and analysis Supervisor s responsibilities Program Review A review of this program will be made annually by the STF Prevention Program Manager to ensure the adherence of best practices and regulatory requirements, and to monitor the overall effectiveness of this policy. As part of this process, a list of injury records from the (Facility) can be obtained from the Workers Compensation Provider (ALPHA Fund) and should be requested through the Human Resources Department. The report of previous injuries will be used to identify emerging patterns and report on the effectiveness of existing prevention efforts. 3 P a g e

8 Slip, Trip, Fall Prevention Support Materials Post Incidence Response Plan All accidents will be investigated and analyzed to identify the root cause. The following steps will be taken when an accident occurs. 1. Helping the injured person will be the primary concern immediately following an accident. 2. Never leave the person alone. If assistance is needed send someone else or have someone stay with the person while you get help. 3. Protect the accident scene to prevent anyone else from getting hurt and to preserve the accident scene in an as is condition to help ensure an accurate investigation. 4. Contact the supervisor of the area where the accident occurred so they can begin the collection of data and accident analysis. 5. The information will be collected and the analysis completed using our Accident Investigation Report. (or whatever the name of Facility document is) 6. Photos need to be taken of the general area, any defective conditions and anything else that could be considered as a contributing factor of the accident. 7. Once the root cause is determined, corrective action will be initiated immediately following standard procedure. Walking & Working Surface Inspection Check Lists Available for: Hospitals for common areas Hospitals for departments Clinics Hospice Facilities & Offices Hospice Patient Residence Please use the check list appropriate for your facility. 1 P a g e

9 Safety Rules The following basic safety rules have been established to help us prevent slip, trip and fall accidents. These rules are in addition to safety rules that must be followed when doing particular jobs or operating certain equipment. Failure to comply with these rules will result in disciplinary action. Always take the proper safety precautions before doing a job. If a job is unsafe, report it to your supervisor. We will find a safer way to do that job. Horseplay, running and fighting are prohibited Clean up spills immediately. Replace all cleaning tools and supplies after use. Keep equipment or materials out of designated walkways. Protect all spill areas. If needed, get someone to help clean up the spill or guard the spill while you get the necessary equipment to clean the spill. If you see a slip or trip hazard do something about it. It s the responsibility of everyone to identify and control hazards. Make sure proper housekeeping standards are followed at all times. Good housekeeping helps prevent injuries. Housekeeping Standards Housekeeping plays such a critical role in the success of our slip, trip and fall prevention program that all employees must make housekeeping their top priority. The following are minimum accepted guidelines: Work areas are to be kept clean throughout your shift and a thorough review and cleaning must be completed prior to leaving your shift. Walkways will be kept clear of electric cords, tubing or any other potential hazards. If walkways cannot be kept clear then they need to be blocked off until the task is completed. Spill areas must be secured until the spill is removed. Spare equipment and supplies will not be stored on stairs, in walkways or in such a manner that would be a hazard to anyone walking through. Seasonal Issues The changing seasons create unique weather-related conditions for which the following procedures have been developed: Winter snow and ice removal: All building entrances will be inspected hourly, cleaned of snow and ice, and will be treated with salt. Exterior walkways will be inspected hourly and treated as needed. Parking lots will be inspected daily. Any snow or ice that has accumulated between cars will need to be removed. 2 P a g e

10 During the fall: Daily inspections will be made and action taken as needed to ensure walkways and drains are cleared of leaves. Maintenance department will make weekly inspections of gutters and clean as necessary. Corrective Maintenance Procedures When a hazard has been identified through inspection or our hazard reporting program, maintenance must be notified so that the problem can be corrected. The following is the procedure to accomplish this task: Any problem needs to be communicated to the manager immediately. The maintenance manager will inspect the problem and communicate the best action to take. If it can t be corrected immediately, a temporary control will be put in place to prevent anyone from being injured. Footwear Policy Proper footwear is an important component of our slip, trip and fall prevention program. Footwear needs to be appropriate for the task. It is the responsibility of each employee to obtain and maintain slip resistant footwear in a serviceable condition. Supervisors will ensure that our uniform footwear policy is adhered to and employees are wearing appropriate slip resistant footwear at all times in the workplace. 3 P a g e

11 Training and Awareness Resources Training Videos ALPHA Lending Library Slips, Trips, and Falls: Avoiding Injury in Your Workplace Slips and fall account for more than 200,000 on-the-job injuries in the United States each year. The fast-paced program identifies major slip, trip, and fall hazards that may endanger your employees Negotiating slippery surfaces Controlling hazards Avoiding falls DVD available in Spanish 14 Minutes Video Reference # Fall Prevention for General Industry Falls are the fourth leading cause of work-related fatalities in the United States. This 20-minute video will show some of the most common fall hazards and explain how your employees can avoid them, which can also keep insurance premiums low, maintain productivity, and control workers compensation costs. This video includes; Fall-Protection systems Surface hazards Stairs Work surfaces Scaffolds Personal Protective Equipment 20 Minutes Video Reference #

12 Training and Awareness Resources Training Videos ALPHA Lending Library Preventing Patient Falls in Hospitals Healthcare professionals are on the front lines of pro-active fall prevention. This program is designed to help train your employees on the proper assessment tools and protective strategies you can use to take the guesswork out of fall prevention. The three types of falls Conducting a fall assessment Preventing falls Fall prevention for at-risk or fall-prone patients Communicating risk & preventing falls 15 Minutes Video Reference #

13 Training and Awareness Resources Awareness Posters Winter Poster Walking on snow & ice Proper Training Helps Everyone Work Safely

14 Training and Awareness Resources Slipping Hazards in the Workplace Call ALPHA Fund to Request Posters

15 Hospitals Slip Trip Fall Check List Department DEPARTMENT & Name of employee: Date [Name] [Date] Indoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Do tiles, linoluem, or other flooring have holes, cracks or bumps? Is carpeting buckled, loose, or frayed? Does floor feel greasy or slippery? Are liquid contaminants present (water, oil, grease, cleaning solutions, coffee, body fluids)? Are dry contminants present (powder, dirt, flour, food, wax chips)? Are there sudden changes >1/4ʺ Are slip resistant mats used in wet areas? Are water absorbent walk off mats used in entrances? Contamination & Irregularities Lighting Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Are light bulbs burned out? Are areas dim, poorly lit, or shadowy? Are lighting levels compliant with local codes, ANSI, and/or illuminating Engineering Society (IESNA) recommendations? Page 1 of 2

16 Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing) Within Department Yes No Description and Corrective Action Needed Date Completed Are cords bundled using cord organzer? Are cords on the floor covered with a beveled protective cover or tape? Are cords mounted under the desk or on equipment? Are hallways, stairs, and walkways clear of cluter (boxes, cords equipment)? Is there appropriate storage (closet, shelves, hooks, lockers)? Are stepstools available for use in areas with overhead storage? Do rolling office shairs have a sturdy base (no less than 5 legs)? Employee Communications (Training and Employee Involvement) Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Do all employees know the contact number for the housekeeping Are winter weather warnings distributed to staff through ? Are all employees aware of the housekeeping procedures? Do employees know where safety products are stored? Are cleaning methods for all floors and paths recorded and displayed? Are employees that use ladders trained in safe ladder use and maintenance? Page 2 of 2

17 Hospitals: Slip Trip Falls Check List by Department Staff Member & Location [Name] Date [Date] DEPARTMENT Administration LAST DATE INSPECTEDNEXT INSPECTION DUE DESCRIPTION AND CORRECTIVE ACTION NEEDED DATE COMPLETED Admitting Cardiac Specialty Central Service Central Transport Dietary Emergency Department Environmental Services Health Information ICU Labor & Delivery Laboratory Med Surg Obstetrics Operating Rooms Pharmacy Physical Therapy PACU Radiology Skilled Nursing Surgery Page 1 of 1

18 Hospitals: Slip Trip Fall Check List For Common Areas COMMON AREAS Name of STF Admin Date [Name] [Date] Contamination & Irregularities Indoor Common Areas Indoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Do tiles, linoluem, or other flooring have holes, cracks or bumps? Is carpeting buckled, loose, or frayed? Does floor feel greasy or slippery? Are liquid contaminants present (water, oil, grease, cleaning solutions, coffee, body fluids)? Are dry contaminants present (powder, dirt, flour, food, wax chips)? Are there sudden changes >1/4ʺ Are water absorbent walk off mats used in entrances? Are slip resistant mats used in wet areas? Are mats in good condition and appropriate for the area? Contamination & Irregularities Outdoor Common Areas Outdoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Are there gaps, cracks, or holes in the outdoor walkway > 1/2ʺ? Are there metal grates or mesh flooring the walkway? Is the walkway uneven, with abrupt changes in level > 1/2ʺ? Is there debris (pebbles, rocks, leaves, grass cllippings) on walkway? Are there any slippery conditions present (water, ice, snow, grease)? Are concrete wheel stops in the parking areas highlighted with paint? Page 1 of 5

19 Drainage: Pipes and Drains Common Areas Inside and outside the hospital Yes No Description and Corrective Action Needed Date Completed Are drains clogged or filled with debris? Are pipes splashing water onto walking surface? Are outside drain pipes or down spouts spilling water on walkways? Are pipes properly aligned with drains inside and outside the hospital? Weather Conditions (Ice and Snow) Where Applicable Yes No Description and Corrective Action Needed Date Completed Are bins containing ice melting chemicals and scoops provided at areas of heavy pedestrian traffic? Are ice melting chemicals swept up once walkways are dry? Is winter weather communications distribution system in place? Is snow removal appropriately scheduled? Stairs and Handrails Common Areas Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Are all handrails 34 38ʺ from floor? Are handrails provided on slopes, ramps, stairs? Do handrails extend at least as far as the last step? Are handrails provided at steps (employee shuttle bus stop, entrances, conference and training rooms)? Are the edges / noses of each step painted or marked? Are stairway risers and steps all uniform size? Page 2 of 5

20 Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing) Common Areas Inside the hospital Yes No Description and Corrective Action Needed Date Completed Are cords bundled using cord organzer? Are cords on the floor covered with a beveled protective cover or tape? Are cords mounted under the desk or on equipment? Are hallways, stairs, and walkways clear of cluter (boxes, cords equipment)? Is there appropriate storage (closet, shelves, hooks, lockers)? Are stepstools available for use in areas with overhead storage? Do rolling office shairs have a sturdy base (no less than 5 legs)? Lighting Common Areas Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Are light bulbs burned out? Are areas dim, poorly lit, or shadowy? Are lighting levels compliant with local codes, ANSI, and/or illuminating Engineering Society (IESNA) recommendations? Mats Common Areas Inside the hospital Yes No Description and Corrective Action Needed Date Completed Do mats have abrupt squared off edges, lacking a bevel? Are mat edges curled up or flipped over? Do mates slide around on the floor? Page 3 of 5

21 If applicable Yes No Description and Corrective Action Needed Date Completed Are employees wearing slip resistant shoes (safety shoe marketed as slipresistant)? Do shoe soles have worn down tread? Is the shoe sole tread clogges with dirt, food, debris, or snow? Are employees that must work outside wearing slip resistant footwear? Slip Resistant Shoes Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Are changes in walkway elevation highlighted? Are curbs highlighted? Are highly visible wet floor signs available and used correctly? Are barriers available and used to prevent access into wet or dangerous areas? Are wet floor signs removed promptly once floor is dry/clean? Visual Cues Common Areas Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Are the following products available and conveniently located throughout the hospital? Cups near water fountains? Wall mounted spill absorbant pads or paper towels? Trash cans? Pop up tent floor signs? Umbrella bags? Barrier and access restriction devices? Safety Products Employee Communications (Training and Employee Involvement) Page 4 of 5

22 Inside / Outside the hospital Yes No Description and Corrective Action Needed Date Completed Do all employees know the contact number for the housekeeping department? Are winter weather warnings distributed to staff through ? Are all employees aware of the housekeeping procedures? Do employees know where safety products are stored? Are cleaning methods for all floors and paths recorded and displayed? Are employees that use ladders trained in safe ladder use and maintenance? Page 5 of 5

23 Hospice Patient Residence: Slip Trip Fall Check List Staff Member & Location Date [Name] [Date] Indoor Irregularities Indoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Do floor coverings have holes, cracks or bumps? Is carpeting buckled, loose, or frayed? Does floor feel greasy or slippery? Are liquid contaminants present (water, oil, grease, cleaning solutions, coffee, body fluids)? Are dry contminants present (powder, dirt, flour, food, clutter)? Are there sudden changes >1/4ʺ Are throw rug or mats used in entrances? Do throw rugs or mats slide? Are light bulbs burned out? Are areas dim, poorly lit, or shadowy? Outdoor Irregularities Outdoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Are there gaps, cracks, or holes in the outdoor sidewalk or walkway > 1/2ʺ? Is the walkway uneven, with abrupt changes in level > 1/2ʺ? Is there debris (pebbles, rocks, leaves, grass cllippings) on walkway? Are there any slippery conditions present (water, ice, snow, grease)? Do tree roots that create a trip hazard? Are the parking areas in good condition? Outdoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Are all handrails 34 38ʺ from floor? Are handrails provided on slopes, ramps, stairs? Do handrails extend at least as far as the last step? Are stairway risers and steps all uniform size? Stairs and Handrails, if applicable Page 1 of 1

24 Hospice Facilities & Offices: Slip Trip Fall Check List Staff Member & Location Date [Name] [Date] Contamination & Irregularities Indoor walking and working surfaces Do tiles, linoluem, or other flooring have holes, cracks or bumps? Is carpeting buckled, loose, or frayed? Does floor feel greasy or slippery? Are liquid contaminants present (water, oil, grease, cleaning solutions, coffee, body fluids)? Are dry contminants present (powder, dirt, flour, food, wax chips)? Are there sudden changes >1/4ʺ Are water absorbent walk off mats used in entrances? Are slip resistant mats used in wet areas? Yes No Description and Corrective Action Needed Date Completed Outdoor walking and working surfaces Are there gaps, cracks, or holes in the outdoor walkway > 1/2ʺ? Are there metal grates or mesh flooring in the walkway? Is the walkway uneven, with abrupt changes in level > 1/2ʺ? Is there debris (pebbles, rocks, leaves, grass cllippings) on walkway? Are there any slippery conditions present (water, ice, snow, grease)? Are concrete wheel stops in the parking areas in good condition and highlighted with paint? Contamination & Irregularities p Yes No Needed Date Completed Page 1 of 4

25 Inside and outside Are drains clogged or filled with debris? Are pipes splashing water onto walking surface? Are outside drain pipes or down spouts spilling water on walkways? Are pipes properly aligned with drains inside and outside the facility? Drainage: Pipes and Drains p Yes No Needed Date Completed Weather Conditions (Ice and Snow) Where Applicable g scoops provided at areas of heavy pedestrian traffic? Are ice melting chemicals swept up once walkways are dry? Is winter weather communications distribution system in place? Is snow removal appropriately scheduled? g Yes No Description and Corrective Action Needed Date Completed Stairs and Handrails, if applicable Inside / Outside Yes No Description and Corrective Action Needed Date Completed Are all handrails 34 38ʺ from floor? Are handrails provided on slopes, ramps, stairs? Do handrails extend at least as far as the last step? Are handrails provided at steps (employee shuttle bus stop, entrances, conference and training rooms)? Are the edges / noses of each step painted or marked? Are stairway risers and steps all uniform size? Page 2 of 4

26 Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing) Inside Yes No Description and Corrective Action Needed Date Completed Are cords bundled using cord organzer? Are cords on the floor covered with a beveled protective cover or tape? Are cords mounted under the desk or on equipment? Are hallways, stairs, and walkways clear of cluter (boxes, cords equipment)? Is there appropriate storage (closet, shelves, hooks, lockers)? Are stepstools available for use in areas with overhead storage? Do rolling office shairs have a sturdy base (no less than 5 legs)? Lighting Inside / Outside Are light bulbs burned out? Are areas dim, poorly lit, or shadowy? Are lighting levels compliant with local codes, ANSI, and/or illuminating Engineering Society (IESNA) recommendations? Yes No Description and Corrective Action Needed Date Completed Mats Inside Do mats have abrupt squared off edges, lacking a Are mat edges curled up or flipped over? Do mates slide around on the floor? Yes No Description and Corrective Action Needed Date Completed If applicable Are employees wearing slip resistant shoes (safety shoe marketed as slip resistant)? Do shoe soles have worn down tread? Is the shoe sole tread clogges with dirt, food, debris, or snow? Are employees that must work outside wearing slipresistant footwear? Slip Resistant Shoes Yes No Description and Corrective Action Needed Date Completed Visual Cues Page 3 of 4

27 Inside / Outside Yes No Description and Corrective Action Needed Date Completed Are changes in walkway elevation highlighted? Are curbs highlighted? Are highly visible wet floor signs available and used correctly? Are barriers available and used to prevent access into wet or dangerous areas? Are wet floor signs removed promptly once floor is dry/clean? Safety Products Inside / Outside Are the following products available and conveniently located throughout the facility? Cups near water fountains? Wall mounted spill absorbant pads or paper towels? Trash cans? Pop up tent floor signs? Umbrella bags? Barrier and access restriction devices? Yes No Description and Corrective Action Needed Date Completed Employee Communications (Training and Employee Involvement) Inside / Outside Do all employees know the contact number for the housekeeping department? Are winter weather warnings distributed to staff through ? Are all employees aware of the housekeeping procedures? Do employees know where safety products are stored? Are cleaning methods for all floors and paths recorded and displayed? Are employees that use ladders trained in safe ladder use and maintenance? Yes No Description and Corrective Action Needed Date Completed Page 4 of 4

28 Clinics: Slip Trip Fall Check List Staff Member & Location Date [Name] [Date] Contamination & Irregularities Indoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Do tiles, linoluem, or other flooring have holes, cracks or bumps? Is carpeting buckled, loose, or frayed? Does floor feel greasy or slippery? Are liquid contaminants present (water, oil, grease, cleaning solutions, coffee, body fluids)? Are dry contminants present (powder, dirt, flour, food, wax chips)? Are there sudden changes >1/4ʺ Are water absorbent walk off mats used in intrances? Are slip resistant mats used in wet areas? Outdoor walking and working surfaces Yes No Description and Corrective Action Needed Date Completed Are there gaps, cracks, or holes in the outdoor walkway > 1/2ʺ? Are there metal grates or mesh flooring the walkway? Is the walkway uneven, with abrupt changes in level > 1/2ʺ? Is there debris (pebbles, rocks, leaves, grass cllippings) on walkway? Are there any slippery conditions present (water, ice, snow, grease)? Are concrete wheel stops in the parking areas in good condition and highlighted Contamination & Irregularities Page 1 of 5

29 Inside and outside the clinic Yes No Description and Corrective Action Needed Date Completed Are drains clogged or filled with debris? Drainage: Pipes and Drains Are pipes splashing water onto walking surface? Are outside drain pipes or down spouts spilling water on walkways? Are pipes properly aligned with drains Weather Conditions (Ice and Snow) Where Applicable Yes No Description and Corrective Action Needed Date Completed Are bins containing ice melting chemicals and scoops provided at areas of heavy pedestrian traffic? Are ice melting chemicals swept up once walkways are dry? Is winter weather communications distribution system in place? Is snow removal appropriately scheduled? Inside / Outside the clinic Yes No Description and Corrective Action Needed Date Completed Are all handrails 34 38ʺ from floor? Are handrails provided on slopes, ramps, stairs? Do handrails extend at least as far as the last step? Are handrails provided at steps (employee shuttle bus stop, entrances, conference and training rooms)? Are the edges / noses of each step painted or marked? Are stairway risers and steps all uniform Stairs and Handrails, if applicable Page 2 of 5

30 Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing) Inside the clinic Yes No Description and Corrective Action Needed Date Completed Are cords bundled using cord organzier? Are cords on the floor covered with a beveled protective cover or tape? Are cords mounted under the desk or on equipment? Are hallways, stairs, and walkways clear of cluter (boxes, cords equipment)? Is there appropriate storage (closet, shelves, hooks, lockers)? Are stepstools available for use in areas with overhead storage? Do rolling office chairs have a sturdy base (no less than 5 legs)? Lighting Inside / Outside the clinic Yes No Description and Corrective Action Needed Date Completed Are light bulbs burned out? Are areas dim, poorly lit, or shadowy? Are lighting levels compliant with local codes, ANSI, and/or illuminating Engineering Society (IESNA) Mats Inside the clinic Yes No Description and Corrective Action Needed Date Completed Do mats have abrupt squared off edges, lacking a bevel? Are mat edges curled up or flipped over? Do mates slide around on the floor? Page 3 of 5