Trane Facilities Assessment

Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location

Site Contact info

Name
Title
Address
Work phone
Cell Phone
Email Address
Other details

Staffing Assessment

Staffing assessment

Is there currently in-house maintenance
Define staffing levels and skill sets
Is there Janitorial Staff
Define staffing levels and skill sets
Is there food service staff at this location
Define staffing levels and skill sets
Other Staff info
Define staffing levels and skill sets

Facilities Structure Info

Facilities Structural informantion

Structure Type
Number of Stories
Total Square Footage
Square Fottage of Office
Square Footage of Warehouse
Square Footage of Prodiction
Square footage of Other
Define the Square Footage
Total Arcers
Parking type
Total Number of Stalls
Storefront Type
Storefront Color (include color code and manufacture if possible)
Glazing Color (include color code and manufacture if possible)
Structural Color (include color code and manufacturer if possible)
Number of Exits
Number of Dock Door if applicable

Facilities Utilities Assessment

Electrical Service
Provider info/ Contact
Main Utility Input to Facilities
MD Voltage/ Amperage/ Phase
Ground fault protection
Provide details about the system
Lighting protection
Provide details about the system
General Comments
Gas Utility
Service Provider / Contact
Main Pressure high or low
Main and meter protected from damage
Provide Reason for partial compliance
General Comments
Water Service
Service Provider / Contact
Main Size / Pressure
Cross connect Service Provider / Contact
Inspection up to date
Provide Reason for partial compliance
Are valves secured
Provide Reason for partial compliance
General Comments
Waste Removal
Provider / Contact
Type of removal (dumpster or compactor)
Estimated pulls or tons per month
Define Schedule of pick up's
General Comments

Standard Operating Procedures Manual Assessment

Standard Operating Procedures Manual

Approval page is signed/dated by Department Manager and Administration.
Provide Reason for partial compliance
There is a current department organization chart
Provide Reason for partial compliance
Copies of all policies and procedures are included in appropriate sections
Provide Reason for partial compliance
Maintenance Request System procedure is approved by Administration
Provide Reason for partial compliance
Job descriptions are included for all current positions
Provide Reason for partial compliance
All documentation, logs and maintenance records are retained for a minimum of 3 years
Provide Reason for partial compliance
General Comments

Emergency Contingency Plans Assessment

Emergency Contingency Plans include:

Up to date call roster for department personnel
Provide Reason for partial compliance
Vendor call list
Provide Reason for partial compliance
Procedure for air conditioning failure
Provide Reason for partial compliance
Procedure for boiler failure
Provide Reason for partial compliance
Procedure for plumbing failure
Provide Reason for partial compliance
Procedure for elevator failure
Provide Reason for partial compliance
Procedure for communications failure
Provide Reason for partial compliance
Procedure for natural gas failure
Provide Reason for partial compliance
Procedure for water system failure
Provide Reason for partial compliance
Procedure for commercial electrical failure
Provide Reason for partial compliance
Procedure for emergency generator failure
Provide Reason for partial compliance
Procedure for fire alarm system failure
Provide Reason for partial compliance
Procedure for fire sprinkler system failure
Provide Reason for partial compliance
Procedure for piped medical gases failure (hospital only)
Provide Reason for partial compliance
Procedure for piped vacuum system/compressed air failure
Provide Reason for partial compliance
Procedure for oxygen system failure (hospital only)
Provide Reason for partial compliance
Single line diagrams of all systems are available
Provide Reason for partial compliance
Site plan showing all major utility shutoffs is available
Provide Reason for partial compliance
General Comments

Life Safety Testing and Inspection Assessment

Fire drills

Fire drills are documented in the Life Safety Manual
Provide Reason for partial compliance
Fire drills cover all personnel, one per shift, per quarter (once per year for stand-alone business occupancies)
Provide Reason for partial compliance
Fire drills are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
General Comments

Fire extinguishers

There is an inventory of all fire extinguishers and are they scheduled for monthly inspections
Provide Reason for partial compliance
Fire extinguisher inspections are up to date for the last 12 months
Provide Reason for partial compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance
Extinguishers and cabinets are numbered and clearly visible
Provide Reason for partial compliance
Extinguishers are maintained annually
Provide Reason for partial compliance
General Comments

Fire / Weather Alarm System Panel Assessment

Pull stations

There is an inventory of all pull stations
Provide Reason for partial compliance
All pull stations are numbered
Provide Reason for partial compliance
All pull stations are tested annually
Provide Reason for partial compliance
Pull station tests are up to date for the last 12 months
Provide Reason for partial compliance
General Comments

Horns, speakers and strobes

There is an inventory of all fire alarm horns, speakers and strobes
Provide Reason for partial compliance
All horns, speakers and strobes are tested annually
Provide Reason for partial compliance
Tests are up to date for the last 12 months
Provide Reason for partial compliance
All horns, speakers and strobes are numbered
Provide Reason for partial compliance
General Comments

Fire Alarm and Supervisory Signal Devices

Transmission of fire alarm signals to off-premises monitoring site is tested quarterly
Provide Reason for partial compliance or non-compliance
There is an inventory of all supervisory signal devices
Provide Reason for partial compliance
Devices are tested quarterly
Provide Reason for partial compliance
Tests are up to date for the last 12 months
Provide Reason for partial compliance
Monitoring Company / Contact
General Comments

Smoke, duct and heat detectors

There is an inventory of all Smoke, Heat and Duct Detectors
Provide Reason for partial compliance or non-compliance
All Smoke, Duct and Restoreable Heat Detectors are Tested Annually
Provide Reason for partial compliance
All non-restoreable heat detectors are tested mechanically and electrically annually (2 per 100) every 15 years
Provide Reason for partial compliance
All detectors are numbered
Provide Reason for partial compliance
Detectors are tested annually and documented for the past 12 months
Provide Reason for partial compliance or non-compliance
Smoke Detector Information
Manufacture
Current Service vendor / Contact
General Comments
Heat Detector Information
Manufacture
Current Service vendor / Contact
General Comments
Duct Detector Information
Manufacture
Current Service vendor / Contact
General Comments

Fire and smoke dampers

There is an inventory of all fire and smoke dampers
Provide Reason for partial compliance
All fire and smoke dampers are tested (with fusible links removed where applicable) every four years to verify they fully close
Provide Reason for partial compliance
General Comments

Smoke detection shutdown devices`

There is an inventory of all automatic smoke detection shutdown devices for air handling equipment
Provide Reason for partial compliance
Devices are tested annually
Provide Reason for partial compliance
Tests are up to date for the last 12 months
Provide Reason for partial compliance
General Comments

Sprinkler flow alarms

There is an inventory of all sprinkler flow alarm locations
Provide Reason for partial compliance
Alarms are scheduled for semiannual testing.
Provide Reason for partial compliance
Tests are up to date for the last 12 months
Provide Reason for partial compliance
General Comments

Sprinkler Systems Assessment

There is an inventory of all system risers
Provide Reason for partial compliance
Sprinklers, pipe and fittings, hangers and seismic braces, and spare sprinklers are inspection annually from floor level. Concealed spaces are exempted
Provide Reason for partial compliance
Antifreeze is tested annually if applicable
Provide Reason for partial compliance
Sprinklers and spray nozzles protecting cooking equipment and ventilating systems are replaced annually (except bulb-type with no buildup of grease or other
Provide Reason for partial compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance
General Comments

Sprinkler control valves

There is an inventory of all sprinkler control valve locations
Provide Reason for partial compliance
Valves are scheduled for monthly inspection (weekly if not locked or supervised)
Provide Reason for partial compliance
Supervisory or tamper switches are tested semiannually
Provide Reason for partial compliance
Valves are operated annually
Provide Reason for partial compliance
Valves are maintained annually
Provide Reason for partial compliance
Tests are up to date for the last 12 months
Provide Reason for partial compliance
General Comments

Main drains

There is an inventory of all system risers with locations
Provide Reason for partial compliance
Main drain tests are conducted at least annually on all system risers
Provide Reason for partial compliance
General Comments

Dry pipe sprinkler systems

There is an inventory of all dry pipe sprinkler systems
Provide Reason for partial compliance
Gauges are inspected weekly (monthly with low-pressure alarm)
Provide Reason for partial compliance
Valves are inspected monthly
Provide Reason for partial compliance
Priming water level and low pressure alarms are checked quarterly
Provide Reason for partial compliance
Quick-opening devices are tested quarterly
Provide Reason for partial compliance
Valves are trip tested annually with partial flow
Provide Reason for partial compliance
Valves are trip tested every three years with full flow
Provide Reason for partial compliance
General Comments

Preaction or deluge systems

There is an Inventory of all Preaction Sprinkler Systems
Provide Reason for partial compliance
Systems are scheduled for test & inspection per NFPA requirements.
Provide Reason for partial compliance
Inspections are recorded for past 12 months
Provide Reason for partial compliance
General Comments

Stand pipe systems

There is an inventory of all stand pipe systems
Provide Reason for partial compliance
All stand pipe systems are scheduled for water flow and hydrostatic tests at least every five years
Provide Reason for partial compliance
Hose connections and valves are maintained annually
Provide Reason for partial compliance
General Comments

Fire hoses

There is an inventory of all occupant fire hoses
Provide Reason for partial compliance
Fire hoses are hydrostatically tested five years after installation and every three years thereafter
Provide Reason for partial compliance
Fire hose connections are inspected Quarterly
Provide Reason for partial compliance
Hoses are inspected Annually
Provide Reason for partial compliance
General Comments

Fire pumps

Fire pumps are tested weekly under no-flow condition
Provide Reason for partial compliance
Fire pumps are tested annually under flow condition.
Provide Reason for partial compliance
Inspections are recorded for past 12 months
Provide Reason for partial compliance
General Comments

Water storage tanks

Water level alarms are tested at least semiannually
Provide Reason for partial compliance
Low temperature alarms are tested monthly (cold weather only)
Provide Reason for partial compliance
Inspections are recorded for past 12 months
Provide Reason for partial compliance
General Comments

Fire department connections

There is an inventory of all fire department connections
Provide Reason for partial compliance
Fire department connections are inspected quarterly.
Provide Reason for partial compliance
Inspections are recorded for past 12 months
Provide Reason for partial compliance
General Comments

Kitchen Automatic Fire Extinguishing Systems

Kitchen hood systems are maintained at least semiannually
Provide Reason for partial compliance
Inspections are recorded for past 12 months
Provide Reason for partial compliance
General Comments

Kitchen Hood Cleaning

Kitchen hood systems are maintained at least semiannually with high volumes of frying, char broiling or Oriental cooking require more frequent cleaning
Provide Reason for partial compliance
Hood cleaning is up to date
Provide Reason for partial compliance

CO2/Halon/FM200 Systems

There is an inventory of all CO2, Halon, FM200 and other gaseous automatic fire extinguishing systems
Provide Reason for partial compliance
CO2 systems are tested at least annually (actual discharge is not required)
Provide Reason for partial compliance
Halon systems are tested at least semiannually (actual discharge is not required). (JCAHO annual)
Provide Reason for partial compliance
FM200 systems are tested at least semiannually (actual discharge is not required)
Provide Reason for partial compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance
General Comments

Life Safety Policies Assessment

Combustible Decorations

There is a policy prohibiting combustible decorations, unless flame retardant
Provide Reason for partial compliance
The policy is implemented
Provide Reason for partial compliance
General Comments

Portable Space Heaters

There is a policy prohibiting portable space heaters in patient care areas
Provide Reason for partial compliance
The policy is implemented
Provide Reason for partial compliance
General Comments

Building Maintenance Program Assessment

Building Maintenance Program

1-hr and 1½-hr fire doors

There is an inventory of all 1-hr and 1½-hr fire doors
Provide Reason for partial compliance or non-compliance
Doors are tested quarterly for:
Properly functioning positive latching devices
Provide Reason for partial compliance or non-compliance
Properly functioning self- or automatic-closing devices </=1/8 in gaps between meeting edges of door pairs </=3/4 in. undercuts
Provide Reason for partial compliance or non-compliance
General Comments

Linen/trash chute inlet and outlet doors

There is an inventory of all linen/trash chute inlet and outlet doors
Provide Reason for partial compliance or non-compliance
Doors are tested quarterly for: Positive latching devices Self- or automatic-closing devices
Provide Reason for partial compliance or non-compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance or non-compliance

Doors in smoke barriers

There is an inventory of all smoke barrier doors
Provide Reason for partial compliance or non-compliance
Doors are tested quarterly for:
Properly functioning self- or automatic-closing devices
Provide Reason for partial compliance or non-compliance
Maintained to resist the passage of smoke
Provide Reason for partial compliance or non-compliance
General Comments

Corridor doors

Doors are inspected semiannually for:
Properly functioning latching devices
Provide Reason for partial compliance or non-compliance
Maintained to resist the passage of smoke <1 in. undercuts (average)
Provide Reason for partial compliance or non-compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance or non-compliance
General Comments

Smoke barrier wall penetrations

Walls are inspected annually for penetrations
Provide Reason for partial compliance or non-compliance
Penetrations are sealed
Provide Reason for partial compliance or non-compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance or non-compliance
General Comments

Corridor wall penetrations (N/A above suspended ceiling if fully sprinklered)

Walls are inspected annually for penetrations
Provide Reason for partial compliance or non-compliance
Penetrations are sealed
Provide Reason for partial compliance or non-compliance
General Comments

Means of egress illumination devices and exit signs

Devices are inspected quarterly
Provide Reason for partial compliance or non-compliance
Inspections are recorded with dates and initials on tags and log
Provide Reason for partial compliance or non-compliance
All detectors are numbered
Provide Reason for partial compliance or non-compliance
General Comments

Filter Log

There is an inventory of all filters, including location, size, quantity, efficiency, and criteria for changing
Provide Reason for partial compliance or non-compliance
Filters are inspected for torn media or bypass in filter frames following each filter replacement
Provide Reason for partial compliance or non-compliance
Filter changes are up to date for the past 12 months
Provide Reason for partial compliance or non-compliance
Manufacturer's literature/specifications for all filters is included in the Filter Log Manual
Provide Reason for partial compliance or non-compliance
General Comment

Vendor Control Log

A Vendor Control Log is being utilized
Provide Reason for partial compliance or non-compliance
General Comments

Daily Journal/Pass Down Log

The journal is used daily for all shifts
Provide Reason for partial compliance or non-compliance
The journal is bound with numbered pages
Provide Reason for partial compliance or non-compliance
All entries are made in ink
Provide Reason for partial compliance or non-compliance
All entries include the time of occurrence
Provide Reason for partial compliance or non-compliance
All watchstanders read and initial log before start of watch
Provide Reason for partial compliance or non-compliance
General Comments

Maintenance Logs

Maintenance Log

Log is used for rounds daily, all shifts, and includes DHW temperature
Provide Reason for partial compliance or non-compliance
All mechanical equipment spaces are included in the log
Provide Reason for partial compliance or non-compliance
Logs are maintained and available for previous three years
Provide Reason for partial compliance or non-compliance
General Comments

Blueprint Index

Blueprint Index for all buildings is in place and readily available
Provide Reason for partial compliance or non-compliance
Blueprints are neatly filed in a central location
Provide Reason for partial compliance or non-compliance
Blueprints are filed electronically
Provide Reason for partial compliance or non-compliance
General Comments

Schematic diagrams are available for the following equipment:

Electrical Distribution
Provide Reason for partial compliance or non-compliance
Heating Hot Water
Provide Reason for partial compliance or non-compliance
Chilled Water
Provide Reason for partial compliance or non-compliance
Domestic Hot/Cold Water
Provide Reason for partial compliance or non-compliance
Medical Gases (hospital only)
Provide Reason for partial compliance or non-compliance
General Comments

Manufacturers' Index

Manufacturers' Index is in place and readily available
Provide Reason for partial compliance or non-compliance
Manufacturers' literature is neatly filed in a central location
Provide Reason for partial compliance or non-compliance
General Comments

Contracts Manual

Contracts pertaining to maintenance area of responsibility are included in the manual, and contracts are current
Provide Reason for partial compliance or non-compliance
General Comments

Regulatory Agencies Manual

Regulatory Agencies Manual Assessment

Elevator permits are included
Provide Reason for partial compliance or non-compliance
Backflow preventer tests are included
Provide Reason for partial compliance or non-compliance
Fire marshal reports are included
Provide Reason for partial compliance or non-compliance
Fire retardant certificates are included
Provide Reason for partial compliance or non-compliance
Boiler inspections are included
Provide Reason for partial compliance or non-compliance
Health Department inspections are included
Provide Reason for partial compliance or non-compliance
Prior JCAHO Accreditation Decision is included (hospital only)
Provide Reason for partial compliance or non-compliance
Current Statement of Conditions is included
Provide Reason for partial compliance or non-compliance
Current Plan for Improvement (PFI) is included
Provide Reason for partial compliance or non-compliance
Pressure vessel inspections/permits are included
Provide Reason for partial compliance or non-compliance
Personnel licenses are included
Provide Reason for partial compliance or non-compliance
Generator & boiler emissions permits are included
Provide Reason for partial compliance or non-compliance
Sewer discharge permits are included
Provide Reason for partial compliance or non-compliance
General Comments

Emergency Generator Manual

Generator tests are conducted under load for 30 minutes at least monthly (Local jurisdictions may require more stringent testing; e.g., California requires testing every 7 days)
Provide Reason for partial compliance or non-compliance
A written record of inspection, performance, exercising and repairs shall be maintained and available
Provide Reason for partial compliance or non-compliance
All automatic transfer switches are tested monthly
Provide Reason for partial compliance or non-compliance
Power failures are recorded in the manual
Provide Reason for partial compliance or non-compliance
30% load, EGT or annual load bank in place
Provide Reason for partial compliance or non-compliance
General Comments

Electric Bed Manual (hospital)

Electric Bed Manual (hospital only)

There is an inventory of all electric beds
Provide Reason for partial compliance or non-compliance
They are scheduled for at least annual testing in critical care areas They are tested before being put into service for the first time and after repair or modifications (all other areas)
Provide Reason for partial compliance or non-compliance
Inspections are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
General Comments

Receptacle Manual (hospital)

There is an inventory of patient care areas for receptacle tests
Provide Reason for partial compliance or non-compliance
Receptacles in critical care/electrically sensitive areas are scheduled for at least annual testing (California requirement)
Provide Reason for partial compliance or non-compliance
Receptacles in other patient care areas are scheduled for at least annual testing, except hospital grade receptacle testing frequencies can be based on experience (Local jurisdictions may have more stringent requirements.)
Provide Reason for partial compliance or non-compliance
Inspections are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
General Comments

Medical gases

There is an inventory of all medical gas alarms, and they are scheduled for monthly testing
Provide Reason for partial compliance or non-compliance
Inspections of medical gas alarms are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
Annual test of medical gas system components is performed
Provide Reason for partial compliance or non-compliance
There is an inventory of all line isolation monitors, and they are scheduled for monthly testing unless self-testing and self-calibrating
Provide Reason for partial compliance or non-compliance
Inspections of line isolation monitors are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
General Comments

Roof Inspection

A complete roof inventory exists
Provide Reason for partial compliance or non-compliance
Inspections are scheduled quarterly and are up to date for the last 12 months
Provide Reason for partial compliance or non-compliance
Type(s) of roofs
Install date if known
Is there any warranty
Expiration Date
Manufacture
Holder of warranty
Contact infomation
General Comments

Underground Storage Tanks

Underground Storage Tanks Assessment

Automatic Tank Gauging system is operated in test mode monthly
Provide Reason for partial compliance or non-compliance
Weekly manual gauging is used for tanks <1,000 GAL
Provide Reason for partial compliance or non-compliance
The following records are available:
Monitoring results for the previous 12 months
Provide Reason for partial compliance or non-compliance
Performance claims by leak detection system manufacturer
Provide Reason for partial compliance or non-compliance
Records of corrosion protection system tests and inspections
Provide Reason for partial compliance or non-compliance
Records of repair or upgrade to tank
Provide Reason for partial compliance or non-compliance
Records of maintenance, repair and calibration of leak detection equipment
Provide Reason for partial compliance or non-compliance
General Comments

Water Treatment

Water treatment samples of boiler water and appropriate other samples (feed water, condensate), are taken in accordance with water treatment company recommendations
Provide Reason for partial compliance or non-compliance
Blowdown of boilers is performed on a regularly scheduled basis in accordance with water treatment company recommendations
Provide Reason for partial compliance or non-compliance
Boiler blowdowns are recorded, including time and duration, on test result sheet or journal
Provide Reason for partial compliance or non-compliance
Test samples of cooling tower water are taken and test results recorded in accordance with water treatment company recommendations
Provide Reason for partial compliance or non-compliance
Domestic potable water supply from an independent source is treated and subjected to quarterly bacteriological analysis
Provide Reason for partial compliance or non-compliance
General Comments

Grounds

Parking lots are free of debris and provide adequate lighting
Handicapped parking spaces are provided and properly marked
Paved areas are in good repair
Grounds are kept free of litter/debris
All landscaping is properly maintained
All trees are trimmed appropriately to avoid power lines and other hazards
There is a policy/procedure for snow removal
Access to Emergency Room is clearly marked (hospital only)
Recreational areas (tennis courts, swimming pools, etc.) are in good repair
General Comments

Mechanical Equipment / Physical Plant Inventory

Mechanical Equipment Equipment Spaces / Physical Plant

Doors to mechanical equipment rooms are locked
Doors to mechanical equipment rooms are labeled
Penetrations in equipment room floors and walls are sealed
Equipment room floors and walls are clean
Equipment is clean and free of leaks and rust
Equipment room floors are sealed or painted
Piping insulation is in good condition
Piping is labeled as to contents or color coded, and directional arrows are affixed
Valve charts are posted
Valves are numbered and tagged in accordance with valve charts
Permits and inspections listed in 12, Regulatory Agencies Manual, are posted if required by authority having jurisdiction
Operating instructions are posted for the following equipment:
Boilers
Deaerators
Chillers
Water Softeners
Fire pumps
Vacuum Pumps
Emergency Generators
Signs indicating "Warning - This equipment starts automatically" are posted where applicable
Equipment is tagged in accordance with CMMS tag numbering system
Air handling units, exhaust fans, supply fans, and emergency generator(s) are labeled for areas served
Electrical breakers and controls are marked for equipment served
Temperature and pressure gauges are in operable condition range, and equipment is operating within the range
Mechanical equipment rooms are equipped with fire extinguishers
Storage in mechanical equipment rooms limited to engineering related items
Operators' licenses (stationary engineer, etc.) are posted if required
Safety guards are on equipment, as needed
Eyewash stations are available within 10 seconds travel time from areas in which caustic or toxic materials are used within the facility
Electrical rooms have 3 feet clearance in front of equipment
There is no storage on top of electrical gear or in transformer vaults
General Comments

Equipment at site

Unitary Equipment including but not limited to Heat Pumps, Roof Top Units, Make up Air units, Condensers, Furnaces and split systems
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Chillers
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Cooling towers
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Hot Water Heaters
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Boilers
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments

Refrigeration equipment
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Kitchen Equipment
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Back Up Generator / UPS and other back up systems
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Fuel Storage tanks
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Pressure Vessels
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Air Compressors
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments
Building Controls
ID
Manufacture
Model #
Serial #
Size
Voltage
General Comments

General Safety Compliance Assessment

General Safety

Evacuations routes are posted throughout facility, and they include pull station and fire extinguisher locations
Provide Reason for partial compliance or non-compliance
Exit signs are in place and lighted
Provide Reason for partial compliance or non-compliance
Egresses are not blocked or narrowed
Provide Reason for partial compliance or non-compliance
A copy of the smoking policy is posted in the facility
Provide Reason for partial compliance or non-compliance
An inventory of all chemicals used in the department is available
Provide Reason for partial compliance or non-compliance
MSDS sheets are on file for all materials used within the department
Provide Reason for partial compliance or non-compliance
Lock out / Tag Out Program in Place
Provide Reason for partial compliance or non-compliance
All electrical panels latch and hospital locking policy is followed if appicable
Provide Reason for partial compliance or non-compliance
Potable water supply systems are protected by vacuum breakers or other protective devices approved by the authority having jurisdiction
Provide Reason for partial compliance or non-compliance
Domestic hot water temperature is maintained between 105°F and 120°F (or other range if required by AHJ)
Provide Reason for partial compliance or non-compliance
There is an inventory of all confined spaces
Provide Reason for partial compliance or non-compliance
There is a policy covering permit-required confined spaces
Provide Reason for partial compliance or non-compliance
The policy is in use
Provide Reason for partial compliance or non-compliance
Free-standing gas cylinders are securely chained/supported, and there is a clear distinction between empty and full cylinders
Provide Reason for partial compliance or non-compliance
Piped medical gas shut-off valves are labeled for type of service and area served
Provide Reason for partial compliance or non-compliance
Appropriate Personal Protective Equipment is available for use by Engineering personnel
Provide Reason for partial compliance or non-compliance
Electric tools are properly fitted with grounds or double insulated
Provide Reason for partial compliance or non-compliance
Meters used for testing equipment are calibrated biennially and calibration is documented
Provide Reason for partial compliance or non-compliance
Engineering Office is neat and organized
Provide Reason for partial compliance or non-compliance
Engineering Shop is clean and organized
Provide Reason for partial compliance or non-compliance
General Comments

Hazardous Materials Assessment

Hazardous Materials

Secondary containment is in place for all hazardous material storage tanks
Provide Reason for partial compliance or non-compliance
Training of maintenance workers in safe handling and disposal of hazardous waste and spills is documented
Provide Reason for partial compliance or non-compliance
There is a closed-loop system for tracking hazardous/infectious waste manifests
Provide Reason for partial compliance or non-compliance
There are appropriate storage containers or spaces for hazardous/infectious waste
Provide Reason for partial compliance or non-compliance
General Comments

Materials Management System Assessment

Materials Management System

The Following systems are in place and utilized
Warehouse inventory
Materials Handling Equipment Inventory
Supplier inventory
Tool inventory
General Comments

Infection Control Assessment

Infection Control (Hospitals only)

All employees receive annual Infection control training and training is documented
Provide Reason for partial compliance or non-compliance
All new construction and remodels are reviewed by the infection control committee when deemed appropriate, and an ICRA prepared
Provide Reason for partial compliance or non-compliance
Employees are instructed on the proper wearing apparel in surgical suites
Provide Reason for partial compliance or non-compliance
Engineering personnel are trained in the procedures for entering and leaving isolation areas
Provide Reason for partial compliance or non-compliance
General Comments

Work Order Statistics Assessment

Work Order Statistics

Work Order statistics are reported weekly
Provide Reason for partial compliance or non-compliance
Work Order statistics are reported monthly
Provide Reason for partial compliance or non-compliance
General Comment's

Training Assessment

Training

In-service training meetings are conducted on a monthly basis
Provide Reason for partial compliance or non-compliance
There is a 12-month Program Schedule outlining topics to be reviewed
Provide Reason for partial compliance or non-compliance
Lockout/tagout & construction safety
Provide Reason for partial compliance or non-compliance
Electrical, equipment and tool safety
Provide Reason for partial compliance or non-compliance
Hazardous communication/chemical safety
Provide Reason for partial compliance or non-compliance
Asbestos management (if applicable)
Provide Reason for partial compliance or non-compliance
Bloodborne pathogens
Provide Reason for partial compliance or non-compliance
Infection control
Provide Reason for partial compliance or non-compliance
Fire response/fire drills
Provide Reason for partial compliance or non-compliance
Personal protective equipment
Provide Reason for partial compliance or non-compliance
General Comments

Aesthetics Assessment

Aesthetics

Periodic rounds are scheduled to assess facility aesthetics and signage
Provide Reason for partial compliance or non-compliance
General Comments

Purchasing / Financial Policy Assessment

Purchasing Policies Assessment

There is a policy requiring that proposed acquisitions of bedding, carpeting, drapes, wallcoverings, furniture, etc. be reviewed for fire safety
Provide Reason for partial compliance or non-compliance
The policy is implemented
Provide Reason for partial compliance or non-compliance
A policy/procedure is in place outlining purchasing procedures for the department that clearly outlines who may purchase materials
Provide Reason for partial compliance or non-compliance
The policy is implemented and followed
Provide Reason for partial compliance or non-compliance
General Comments

Financial Tracking Assessment

Actual dollar expenditures for entire department are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
All invoices pertaining to the department are approved by the Department Manager before payment
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for salaries/expenses are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for supplies are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for purchased services are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for overtime are within the facility's actual dollar expenditures for overtime are within the facility's
Provide Reason for partial compliance or non-compliance
There is a five year capital plan
Provide Reason for partial compliance or non-compliance
General Comments

Energy Management Assessment

Energy Management

A monthly record is kept of fuel oil consumption
Provide Reason for partial compliance or non-compliance
A monthly record is kept of Nature Gas consumption
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for fuel oil are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
A monthly record is kept of electrical consumption
Provide Reason for partial compliance or non-compliance
A monthly record is kept of water consumption
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for electricity are within the facility's
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for natural gas are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for water are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Actual dollar expenditures for combined utility consumption are within the facility's budget year-to-date
Provide Reason for partial compliance or non-compliance
Department Manager has provided the facility with a plan for energy conservation and plan is implemented
Provide Reason for partial compliance or non-compliance
General Comments

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