Name:
MAH Admin Area EOC Tracer Tool
Date:
Location:
Observation
g. Hallways Clear (uncluttered) and exit
signs lighted. Elevator areas not used for
storage of extra wheelchairs, stretchers,
beds, etc. Oxygen on/off shuts offs labeled.
 Yes  No N/A
Any in-use portable items must be on the same
side of the hall. No blocking fire/smoke doors, fire
extinguishers, medical gas valves or electrical
panels.
h. No doors propped open or obstructed.
 Yes (no props)
 No
N/A
No door may be propped open. Doors may not be
tied open, either. If is a door that should be able
to stay open, such as door to pt. room, ask staff
member to send work order for repair.
m. Check for any out of date inspection
stickers or frayed cords.
 Yes  No N/A
o. Air Vents are clean.
No stained or damaged ceiling tiles
t. No storage within 18" of ceiling/sprinkler
head
u. Storage areas are neat and orderly. No
unauthorized under sink storage.
v. O2 or bottled gas tanks stored
appropriately
y. Walls in good repair (no holes).
Surfaces are mold and decay-free.
Floor surface in good repair.
Proper lighting - no burned out bulbs.
Furniture in room is in good repair. No rips
or stains in upholstery.
 Yes  No N/A
 Yes  No N/A
 Yes  No N/A
 Yes  No N/A
No boxes on floor. Bottom shelf is solid. Doors
closed to clean Utility or storage Rms.
Tanks in holders or chained; identified empty/full;
no more than 12 full or partial tanks in fire zone.
Deficiencies:
© 2008 Mount Auburn Hospital, 4/17/09
Staff Interview
a. What is your reference for the MAH
Codes and what is the first thing you do in
the event of any Code or Emergency? Can
you tell me the Code for Disaster?
b. What do you do in case of a Code Red on
your unit?
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Yes
No
N/A
Yes
No
N/A
c. Tell me how you would use a fire
extinguisher. Where is the nearest fire
extinguisher? Note if accessible.
    Yes
    No
    N/A
d. Where is the nearest fire alarm pull
station?
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i. What is your role in the event of a Code
Pink page?
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Yes
 Yes
 No
 N/A
 No N/A
j. Tell me about access to the unit/dept or
special security requirements. Bain Birthing
Ctr. Tell me about Infant Security.
 Yes  No N/A
k. What is an MSDS? How do you access
MSDS information?
 Yes  No N/A
Ensure chemicals are labeled with
manufacturers label (no hand labeled) and
stored properly (Check Soiled Utility room
or any equipment processing area)
l. What do you do for a piece of equipment
that does not work?
 Yes  No N/A
p. When do you wear gloves? Gloves are
used appropriately
 Yes  No N/A
My badge. I dial "22" for all Codes and
Emergencies. The code for Disaster is "Code
Triage"
RACE. Rescue any person in immediate danger.
Alarm by dialing "22" or using pull station (show
where the closest station is). Contain the fire close doors. Extinguish if safe to do so or
Evacuate. Proceed with evacuation when
instructed into next smoke/fire compartment.
PASS. Note how easily the staff member locates
the extinguisher. Pull the pin, Aim the spray at the
base of the "fire", Squeeze the handle, and Sweep
the material at the base of the fire. See if staff
can locate and access is clear.
See how easily staff member can locate.
Watch exits (corridors, elevators and stairways).
Observe for duffel bags, large coats, odd
behavior. Call 22 with any information on
suspicious persons.
Are there restricted visiting hours? Restricted
number of visitors? Access control or security.
Material Safety Data Sheet tells you how to
handle chemicals. They may be in cleansers,
equipment, or medications. New Online MSDS
inventory on MT Auburn Caregroup intranet page
- ask staff to show you how to access - show
them if they don't know. Or call x5040 Protection
Services, tell them the chemical/solution. They
will fax information on how to handle.
Remove from area; Complete & apply red "Out of
Service" tag; Send work order to Biomed.
Precaution rooms, contact with blood or body
fluids (Not in hallways or outside patient rooms)
(Not used outside patient care areas)
Notes:
© 2008 Mount Auburn Hospital, 4/17/09