Safety Management Checklists
for the healthcare industry
Safe Patient Handling Program Checklist
This sample checklist highlights many of the important components of a safe patient handling program or policy, including development, management and staff involvement, needs assessments, equipment, education and training, and evaluation. You can use the checklist to help identify those components of your safe patient handling program or policy that are well developed, as well as those that need further development. The checklist can be customized by adding or deleting components specific to your hospital. It is recommended that the checklist be completed at frequent intervals to ensure ongoing program evaluation.
Health Care Provider Safety Checklist
This checklist identifies many important elements of a general safety management efforts. You can use the checklist to help identify those components of your general safety management plan that warrant further development. It is recommended that the checklist be completed at frequent intervals to ensure ongoing program evaluation.
Bloodborne Pathogen Exposure Control Checklist
Bloodborne Pathogens is the most referenced OSHA standard in healthcare facilities. Use this checklist to evaluate efforts to prevent the spread of bloodborne pathogens, which can result in serious diseases like AIDS and chronic hepatitis.
The following is a sample of the customizable safety management checklists relevant to healthcare industry within Midwestern’s Risk Management Center. The Risk Management Center is only accessible to workers’ compensation policyholders of Midwestern Insurance Alliance.
Electrical Safety – Hazard Checklist
This checklist covers electrical safety hazards to watch out for.
Ergonomics Awareness – Caution Zone Checklist
Use this checklist to determine if any typical job activities put employees at risk for ergonomic stress. These are movements or postures that are regularly required to complete a job and are performed more than once per week for more than one week per year. Use a separate checklist for each job position.
Ergonomics Awareness – Hazard Zone Checklist
Use this checklist to determine if any typical job activities of caution zone jobs may put employees at risk of hazardous levels of ergonomic stress. These are movements or postures that are regularly required to complete a job and are performed more than once per week for more than one week per year. Use a separate checklist for each job position.
Food Safety – Components
Checklist for the components of a food safety program for each location.
Hazard Communication – Program Audit
An evaluation form for assessing the completeness of your Hazard Communication Program.
Incident Management Gap Analysis
A simple checklist for an Incident Management Gap Analysis.
Kitchen Safety – Checklist
Daily checklist to determine areas in your kitchen operations requiring corrective action.
Orientation Checklist
A sample checklist for use with new employees to help explain and hold them accountable for proper safety practices.
Patient and Resident Handling Checklist
A safety checklist for moving residents and patients.
Return to Work Program
A program designed for employees who sustain a compensated injury with temporary modified/transitional duties.
Safety Committee Program
This program is designed to promote and assure a safe and healthful work environment and to foster a commitment and involvement of employees and management in this cooperative effort.
Safety Inspection Checklist
A checklist for use during safety inspections and observations.
Slip, Trip, and Fall Prevention – Inspection Form
An inspection form to evaluate your workplace for slip, trip, or fall hazards.
Workers Compensation Calculation Sheet
Calculates the indirect (hidden) costs of incidents.
Workstation Purchasing Specification
A detailed checklist of what to look for when purchasing new workstation materials such as computers, desks and monitors.
