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TJC • CMS • NFPA 99 • OSHA • Infection Control
NFPA 101 / NFPA 99 / TJC LS Standards
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Fire alarm panel visual inspection | Daily | |||
| Manual pull station functional test | Monthly | |||
| Smoke detector sensitivity test (sampling) | Annual | |||
| Heat detector functional test | Annual | |||
| Audible/visual notification device test | Semi-annual | |||
| Fire alarm battery load test | Annual | |||
| Fire watch procedures when system impaired | As needed |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Control valve position verification | Weekly | |||
| Waterflow alarm test | Quarterly | |||
| Sprinkler head visual inspection | Annual | |||
| Main drain flow test | Quarterly | |||
| Fire pump flow test | Annual | |||
| Spare sprinkler head inventory (min 6) | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Visual inspection (all extinguishers) | Monthly | |||
| Professional inspection and tag | Annual | |||
| Hydrostatic pressure test | 5-12 years | |||
| Verify clear access (3 ft clearance) | Monthly | |||
| Check mounting height (max 5 ft to top) | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| 30-second functional test | Monthly | |||
| 90-minute battery discharge test | Annual | |||
| Exit sign illumination check | Monthly | |||
| Battery replacement (per manufacturer) | 5-7 years |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Fire door visual inspection | Monthly | |||
| Fire door operational test | Annual | |||
| Smoke compartment barrier integrity | Annual | |||
| Fire damper operational test | 6 years (initial Year 1) | |||
| Smoke damper operational test | 6 years (initial Year 1) |
TJC EC.02.04.01 / CMS 42 CFR 482.41
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Ventilator PM (per manufacturer) | Per MFR | |||
| Defibrillator functional test | Daily/Shift | |||
| Defibrillator comprehensive PM | Per MFR | |||
| Anesthesia machine PM | Per MFR | |||
| Patient monitoring equipment PM | Per MFR | |||
| Infusion pump PM | Per MFR |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| X-ray equipment PM | Per MFR | |||
| CT scanner PM | Per MFR | |||
| MRI equipment PM | Per MFR | |||
| Ultrasound equipment PM | Per MFR | |||
| Nuclear medicine calibration | Annual | |||
| Radiation safety survey | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Sterilizer biological indicator test | Daily/Each load | |||
| Sterilizer chemical indicator | Each load | |||
| Sterilizer Bowie-Dick test (vacuum) | Daily | |||
| Sterilizer PM | Per MFR | |||
| Sterilizer calibration | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Dialysis machine PM | Per MFR | |||
| Water quality testing (chlorine/chloramine) | Before each shift | |||
| Water bacteria/endotoxin testing | Monthly | |||
| Reverse osmosis system PM | Per MFR |
TJC EC.02.05 / NFPA 99 / NFPA 110
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Generator visual inspection | Daily | |||
| Generator load test (30% min) | Monthly | |||
| Generator transfer test (10 sec) | Monthly | |||
| Generator annual load bank test | Annual | |||
| ATS (Automatic Transfer Switch) test | Monthly | |||
| UPS battery inspection | Monthly | |||
| Generator fuel quality test | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Medical gas alarm panel test | Daily | |||
| Medical gas outlet pressure test | Annual | |||
| Medical vacuum system test | Annual | |||
| Bulk oxygen system inspection | Per vendor | |||
| Medical air compressor PM | Per MFR | |||
| Medical gas piping inspection | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Operating room air pressure verification | Daily | |||
| Isolation room negative pressure check | Daily | |||
| HEPA filter inspection (ORs, isolation) | Annual | |||
| Air changes per hour verification | Annual | |||
| Temperature monitoring (OR 68-75F) | Daily | |||
| Humidity monitoring (OR 20-60%) | Daily |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Electrical panel inspection | Annual | |||
| Ground fault circuit interrupter (GFCI) test | Monthly | |||
| Hospital-grade receptacle test | Annual | |||
| Isolated power system test | Monthly | |||
| Line isolation monitor (LIM) check | Daily |
OSHA 1910.1030 / CDC Guidelines
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Exposure Control Plan review | Annual | |||
| Sharps injury log review | Annual | |||
| Sharps container inspection | Daily | |||
| Engineering controls evaluation | Annual | |||
| Employee BBP training | Annual | |||
| Hepatitis B vaccination offering | Upon hire |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Patient room terminal cleaning audit | Per discharge | |||
| High-touch surface disinfection | Daily/Per shift | |||
| Operating room terminal cleaning | After each case | |||
| Isolation room cleaning protocol | Per protocol | |||
| UV disinfection (if equipped) | Per protocol |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Water management program review | Annual | |||
| Hot water temperature check (>124F) | Monthly | |||
| Cold water temperature check (<68F) | Monthly | |||
| Cooling tower Legionella test | Quarterly | |||
| Dead leg/low flow outlet flushing | Weekly | |||
| Water quality testing (Legionella) | Per risk assessment |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Safety Data Sheet (SDS) review | As updated | |||
| Eyewash station functional test | Weekly | |||
| Emergency shower test | Monthly | |||
| Hazardous material storage inspection | Monthly | |||
| Spill kit inventory | Monthly |
CMS 42 CFR 482.41 / ADA Standards
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Elevator inspection (state certified) | Annual | |||
| Elevator emergency phone test | Monthly | |||
| Elevator recall test (firefighter) | Monthly | |||
| Roof condition inspection | Annual | |||
| Parking structure inspection | Annual | |||
| Window safety device check | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Accessible parking signage & striping | Annual | |||
| Ramp slope and handrail inspection | Annual | |||
| Door opening force test (5 lbs max) | Annual | |||
| Accessible toilet fixture check | Annual | |||
| Grab bar mounting verification | Annual | |||
| Braille/tactile signage condition | Annual |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Infant security system test | Per MFR | |||
| Access control system test | Monthly | |||
| CCTV system inspection | Monthly | |||
| Panic/duress alarm test | Monthly | |||
| Controlled substance storage audit | Per DEA |
| Task / Inspection Item | Frequency | Date Completed | Initials | |
|---|---|---|---|---|
| Medication refrigerator temperature log | Daily | |||
| Medication freezer temperature log | Daily | |||
| Vaccine storage temperature (VFC) | Twice daily | |||
| Medication storage area security | Daily | |||
| Expired medication check | Monthly |