2004 Safety and Management of the Environment of Care Programs TABLE OF CONTENTS POLICY NUMBER

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1 Order The 004 Safety and Management of the Environment of Care Programs at Safety and Management of the Environment of Care Programs LE OF CONTENTS 004 Hospital PolicyNet User Guide Please Read Before Tab 1 EC Education Support Documents for Environment of Care New Hires Audit Tool for Orientation Compliance Monitoring HR..10 LD EC Safety Post Test Summary HR Education 003 Annual Appraisal Form HR..10 HR Sample EC Orientation Packet and Post Test Form HR Performance Improvement Measures for EC 004 EC Committee within the PI Structure Sample 1 EC 004 PI Dashboard (All 7 EC Program PI Measures) EC Committee within the PI Structure Sample LD.4.10 LD.4.0 Over 60 measurable PI measures for the (7) EC Programs EC..0 LD.4.70 LD.4.10 LD.4.0 Environment of Care 1

2 Order The 004 Safety and Management of the Environment of Care Programs at EC Performance Improvement Flow Process Diagram LD.4.10 LD.4.0 Emergency 003 Annual Appraisal Form EC.4.10 Hazardous Material 003 Annual Appraisal Form EC.3.10 Life Safety 003 Annual Appraisal Form EC.5.10 Medical Equipment 003 Annual Appraisal Form EC.6.10 Safety 003 Annual Appraisal Form EC.1.0 Security 003 Annual Appraisal Form EC..10 Utilities 003 Annual Appraisal Form EC.7.10 The Quick & Safe Emergency Response System 3 Wall Mount Safety Station Template Cool Tool for Whole Hospital 3 Emergency Management Program 4 Emergency Preparedness Critique Tool Hospital Emergency Incident Command System (HEICS) Form Part 1 and Part NOTE: As these documents total 3 pages, we suggest that you do not print. Instead, use the electronic versions for reference (e.g., post to your institution s intranet). EC.4.10 EC EC Environment of Care

3 Order The 004 Safety and Management of the Environment of Care Programs at Mass Casualty Disaster Plan Checklist: A Template for Healthcare Facilities EC Sample Hazardous Vulnerability Analysis Form EC Systems Failure and Basic Staff Response Form EC Emergency Management Plan EC Emergency Management PI Measures EC.4.10 EC..0 PI Bioterrorism Readiness Policy EC Community Agencies and Services Policy EC Contingency Emergency Policy EC Earthquake Management Policy EC Emergency Fire Policy EC Emergency Management Sheltering Policy EC Emergency Response Code Tool EC Emergency Response System Code 50 Policy EC Environment of Care 3

4 Order The 004 Safety and Management of the Environment of Care Programs at Emergency Response System Code 500 EC Evacuation Plan Code Red Policy EC Hospital Disaster Policy EC Hurricane Management Policy EC Tornado Policy EC Fire Safety Management Program Statement of Conditions Forms () EC Contractor Daily Checklist Form EC Daily Construction Project Inspection Form EC EC Surveillance Rounds Documentation Form EC Fire Classification Appendix Form EC Fire Drill Critique Form EC Fire Safety Maintenance Test Inspection Frequency Guide Form EC Fire Watch Form EC Environment of Care 4

5 Order The 004 Safety and Management of the Environment of Care Programs at ILSM Notice Posting Form EC ILSM Pre-Construction Inspection Form EC ILSM Training Log Form EC Pre-Construction Infection Control Form EC Fire Safety Management Plan EC Fire Safety Management PI Measures Construction Renovation Policy EC.5.10 EC..0 PI..10 EC Fire Classification and the Use of Fire Extinguishers EC Fire Drill Policy Fire Watch Policy ILSM Measures Policy Hazardous Material & Waste Management Program EC.5.30 EC.5.30 EC.5.50 EC Hazardous Material and Waste Management Plan EC Environment of Care 5

6 Order The 004 Safety and Management of the Environment of Care Programs at Hazardous Material and Waste Management PI Measures EC.3.10 EC..0 PI Chemical Terrorism Policy EC Emergency Eyewash and Shower Equipment Policy EC Handling Waste Mercury and Storage Batteries Policy EC Hazard Communication Plan EC Hazardous Materials Spill Release Policy EC How to Separate and Dispose Notice EC Waste Management of Chemotherapy Policy EC Medical Equipment Management Program 003 Equipment Alarms Annual Appraisal EC Medical Equipment Management Plan EC Medical Equipment Management PI Measures EC.6.10 EC..0 PI Environment of Care 6

7 Order The 004 Safety and Management of the Environment of Care Programs at Equipment Failure and Replacement Policy EC.6.10 EC Private Owned Equipment Policy EC Safety Management Program 8 EC Rounds Survey Schedule Form EC Management of EC Safety Committee Reporting Schedule 8 Sample ECC February 004 Minutes 8 Sample ECC March 004 Minutes 8 Sample January 004 Rounds Summary Report EC Sample Management of the EC Action Plan Report Form PI Sample MS Excel Filtered Safety Rounds Tracker Report Form EC Temperature Log Freezer Form 8 Temperature Log Refrigerator Form Safety Management Plan EC Environment of Care 7

8 Order The 004 Safety and Management of the Environment of Care Programs at Safety Management PI Measures EC.1.0 EC..0 PI EC Manual Signature Approval Form 8 EC Surveillance Rounds Policy EC Flammability Standards Policy EC General Radiation Safety Policy EC General Safety Guidelines Policy EC Safety Officer Authority Statement 8 Safety Officer Job Description 8 Smoke Free Policy EC Smoking and Tobacco Free Policy EC Social Environment: Other Care Considerations Policy EC Security Management Program EC Security Risk Assessment Form EC..10 Environment of Care 8

9 Order The 004 Safety and Management of the Environment of Care Programs at EC Security Summary of Risk Analysis Form EC..10 Security RM Annual Incident Summary EC Security Management Plan EC Security Management PI Measures EC..10 EC..0 PI..10 Bomb Threat Policy EC..10 Cellular Phone Policy EC..10 Firearms and Weapons Policy EC..10 Forensic Officer Safety Policy EC..10 Hostage Plan Policy EC..10 Infant Abduction Policy EC..10 Infant Abduction with Transmitter Policy EC..10 Infant Safety Policy EC..10 Security for Prisoner Forensic Staff Orientation EC..10 HR..10 Environment of Care

10 Order The 004 Safety and Management of the Environment of Care Programs at Sensitive Area Security Policy EC..10 Sensitive Area Security Self Study Guide Forms EC..10 HR..10 Special Events and the Media Policy EC..10 Suspicious Person Policy EC..10 Utilities Management Program 10 Utility Failure Response Form EC Utility Subsystems Testing Intervals Form EC Utility Management Plan EC Utility Management PI Measures EC.7.10 EC..0 PI Equipment and Utility Lockout Tagout Policy EC Heating Devices Policy EC Environment of Care 10