THE AGA KHAN HEALTH SERVICES TANZANIA

Jamat Road, P.O Box 119 Iringa, Tel: 0686 312 490
Email: agakhan@akhst.org – Iringa, Tanzania

EOC Assessment Round Checklist- 2023

EOC AUDITOR: Quality Team Members DATE: 31st March 2023
DEPARTMENTAL
REPRESENTATIVE: Administrative, Nursing, Doctor, FP of Teams MONTH: March (Q1)
LOCATION: All Departments
Instructions: (1) Tick where applicable

S# DESCRIPTION Met NM NA Findings & Closure Responsi

recommendations by date bility
SAFETY PRACTICES

Are the floors, walls, ceilings and general work area clean and in good Entrance gate floor 30th April Admin,
1 repair? √ not cleaned due to no 2023 Nurse In
tarmacked floor. charge
Recommend repair of
entrance floor at the
gate area for easy
cleaning of the area.
Are the floors free from cracks and risks of trips and slips? Entrance gate floor 30th April Admin
2 √ with cracks and risks 2023
of trips.
Recommend
tarmacked area at site
to prevent physical
risks.
3 Are there available hand sanitizing or washing facilities? Room 8, 13, 14 with 30th June Admin
√ hand sanitizing 2023
dispenser.

EOC ASSESMENT ROUND CHECKLIST 1

 Recommend
sanitizing hand
equipment to be
installed to enhance
infection control.
Meanwhile sanitizing
which are at the
corridor to be used as
a temporary solution.
For cleaners available 30th April Nurse in
Are there safety precautionary signs where required i.e. "wet floor", "
4 work in Progress" "No authorized Access", "No Smoking" etc
√ but not used during 2023 charge
activity.
Recommend-
Training to Cleaners
on use of
precautionary sign
and possible risks
factor.
Are the patient room and toilet doors able to open from outside Regular checkup list Closed Nurse in
5 when locked?
√ recommend for charge,
observation room, Admin
dressing room and
toilets for patients.
Is there a functioning emergency call bell in patients' toilet? No usage information 30th June Nurse in
6 √ at toilet 2023 charge
No check list
Recommend- Check
list for Functionality
to Emergency bell in
patient toilet.
To install emergency
bell at disabled toilet.
Where applicable are the patient nurse call bell cords of easy reach to
7 the patients?
Findings & Closure Responsi
S# DESCRIPTION
Met NM NA recommendations by date bility

EOC ASSESMENT ROUND CHECKLIST 1

 Are medication room/ Carts well secured or locked when unattended? Observation Room has 30th April Admin,
8 √ no locks to Emergency 2023 Nurse In
area trolley. charge
Recommend a lock to
Observation room
SECURITY
Is the area under security surveillance Upper Floor and back 30th Sep Admin
9 √ of the building has no 2023
security surveillance
Recommend – Camera
Installation
Where there is potential security risk, is the area manned by security Upper floor and back of 30th Sep Admin
10 guards? √ the building not manned 2023
by security.
Recommend- 2 security
to be available with 1
rotating to upper floor
and at the back
Entrance Point no area 30th Dec Admin,
11 Are measures in place for staff and visitors identification? √ available for such a 2023 OSHA FP
practice. Risk FP
Recommend – a
sheltered security unity
to be built
Is staff interviewed aware of the Emergency codes and how to activate Mostly some able to On going Admin
12 them? √ correctly identify the OSHA FP
Emergency codes. Risk FP
Recommend- Training
of staff with
understanding.
Infection control permit/Pre-construction risk assessment has been
signed before renovation or any construction, regular inspection has √
13 been conducted?

INFECTION CONTROL

Hand hygiene – top prior, Purell and soap dispensers always full and
14 ensure staff are using them.

EOC ASSESMENT ROUND CHECKLIST 1

 All appliances including Ice machines, refrigerators, equipment, bedside
15 furniture clean – no rust no dust
Clean linen covered (the cover is not ripped). Top of linen cart covered;
16 solid bottom on cart.
All soiled linen is in hamper bags (not more than ¾ full), and in soiled
17 room, Clean and dirty linen never stored in the same area
Standards Precautions for all outpatients
18
Relevant personal protective equipment readily available to staff
19
Sharps containers not filled more than 2/3 full, NOT accessible to the
children (unattended on the floor or reachable from the child’s bed/crib
20 or by visiting children)
Reuse of single use items as per policy .
21
Wheelchairs, carts, stretcher and IV poles clean and be prepared to state
22 how you know that they are clean.
Waste disposal as per policy- Appropriate use of Red, Yellow, Green
and Blue bags—Red and Yellow Bins should be covered and adequately
23 secured
No missing, broken, or stained tiles, no torn wall paint
24
Awareness to applicable infection control policies
25
Relevant infection control data posted on staff notice board and shared
26 in their meetings and QC
All contaminated equipment and supplies sent to CSSD- limit cleaning
27 & disinfection in units, if done, CSSD standard protocol followed
Temperature monitored in critical care area, OR, CSSD and sterile
28 supplies Storage areas
Infectious diseases screening at triage & selected clinics
29
HAZARDOUS SUBSTANCES

EOC ASSESMENT ROUND CHECKLIST 1

 Is there an up-to-date list of all hazardous substances used in the Pharmacy has no up to 30th June Pharmacy In
30 workplace? √ date list for their 2023 charge
hazardous substance
No proper storage with 30th June Pharmacy In
31 Hazmat stored in a designated, access controlled cupboard/ room √ no lock. charge
Recommend-
identification of stored
room with lock and key
cupboard.

Incompatible chemicals stored separately i.e. flammable separated √

32 from non-flammable
Are Material Safety Data Sheets (MSDs) available for all hazardous
33 Substances? √
34 Are the MSDs easily accessible to staff?
√
Is the emergency Spill Kit available and appropriate for the HAZMAT
35 in the department? √
Is the storage appropriate in well ventilated and lit rooms and where
36 applicable there is controlled access? √
Are all containers in good condition and properly labeled?
37 √
Where there is emission of dangerous fumes in a confined space, is there
38 adequate means of egress? √
Are the staff interviewed demonstrate safe disposal of the HAZMAT
39 and waste? √
Are the staff interviewed conversant with spill management?
40 √
41 Appropriate PPEs available & and in safe condition ( able to
offer required protection) √
42 Appropriate PPEs use observed during the inspection ( NB: if yes,
indicate how many correct observations made; if no how many incorrect √
observations made)

EOC ASSESMENT ROUND CHECKLIST 1

 Findings & Closure Responsi
S# DESCRIPTION Met NM NA
recommendations by date bility
Where chemicals are mixed/diluted, are the staff interviewed correctly
43 give the right ratios and contact time? √
Are waste segregated in color coded bags or bins as per policy?
44 √
Are the sharps appropriately disposed of recommended sharps
45 containers? √
Are the “Clean Utility” clean enough and where waste is stored have
46 lockable doors? √
Are PPEs provided suitable, adequate and in good condition?
47 √
Is compliance to appropriate PPEs use observed during the audit?
48 √
Where applicable, are there evidence of periodic check or testing of
49 PPEs √
for effectiveness?
50 Where applicable, has training been conducted for PPE use? √
MEDICAL TECHNOLOGY /MACHINES AND TOOLS
Are machines and tools properly guarded where required?
51
Is there evidence of training/ induction on safe use of machines and
52 tools? √
Is there a record for periodic maintenance of machines and tools?
53 √
Are machines and tools in good working order?
54 √
Point of Care testing where applicable (Calibration & Quality Control
55 (QC) checks. √
56 Are defective equipment tagged and taken out of use?
√
UTILITIES( ELECTRICITY ,WATER, VENTILATION, MEDICAL GASES)

EOC ASSESMENT ROUND CHECKLIST 1

 Are all electric equipment well connected and no multiple use of one
57 socket with several equipment? √
Are the electric equipment kept in a dry area and safe from any possible
58 liquid spill? √
Are the power and telephone connections fitted such that they reduce the
59 risk of trailing cables? √
Are there no loose or open electric wires, cracked sockets or switches
60 identified? √
Are there emergency measures during power outage?(e.g. Emergency
61 lights, UPS with critical machines) √
Where compressed medical gases are stored or used, are they well
62 labelled and secured? √
Where there is piped gas, are staff aware of how to shut off the supply in
63 case of emergency? √
64 Are water taps well closed with no dripping?
√
FIRE SAFETY
Are there available and appropriately displayed fire emergency response
65 information for both staff and the public? √
Is there any working installation for fire detection? i.e. manual alarm
66 bell, smoke detector etc. √
Are fire exits free from obstruction?
67 √
Are the staffs interviewed conversant with emergency fire evacuation
68 procedures? √
Are there adequate and appropriate firefighting equipment available?
69 √
Have the firefighting equipment been duly serviced and ready to use?
70 √
Are the employees interviewed aware of the correct use of the available
71 firefighting equipment? √
Are there Fire safety warning signs displayed?
72 √

EOC ASSESMENT ROUND CHECKLIST 1

 73 Is the staff interviewed aware of the Fire Assembly? √
MANDATORY PERIODICAL MEDICAL EXAMINATION
74 Food handlers have undergone six month periodical medical
examination as a mandatory requirement by TFDA, JCIA, and ISO √
[9001-2008], and HACCP.
GRAND TOTAL

NOTES:
1. Feedback should be given to the EOC committee after the inspection
2. There should be agreed timeline for closure of gaps

OBESERVATIONS:

EOC Auditor Sign: Departmental Representative Sign:

Date: Date:

EOC ASSESMENT ROUND CHECKLIST 1

EOC ASSESMENT ROUND CHECKLIST 1
EOC ASSESMENT ROUND CHECKLIST 2
EOC ASSESMENT ROUND CHECKLIST 3
EOC ASSESMENT ROUND CHECKLIST 4
EOC ASSESMENT ROUND CHECKLIST 5
EOC ASSESMENT ROUND CHECKLIST 6
EOC ASSESMENT ROUND CHECKLIST 7