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Behavioral Health Environment of Care Manual

Behavioral Health Environment of Care Manual is a manual containing many of our policy and procedure templates for the medical office, hospital, and other healthcare organizations. The policies cover: Joint Commission (JCAHO or TJC) • CMS • HIPAA • CDC • AAAHC and more.

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Behavioral Health EOC.2.changes Most current changes

Table of Contents - TJC standards Copyright Disclaimer Approval/Signature Sheet Introduction

SECTION 01 - SAFETY MANAGEMENT

Safety Management Program

1001 - Safety Management Plan 1002 - Authority 1003 - Letter of Safety Officer Appointment 1004 - Position Description/Performance Evaluation - Safety Officer 1005 - Performance Evaluation - Population-Specific/Age-Related Competency - Safety Officer 1006 - Annual Competency Skills Assessment - Safety Officer 1007 - Safety/Environment of Care Committee Organizational Chart - Example 1008 - Responsibilities of the Safety/Environment of Care Committee 1009 - Policy Statement - Safety Management 1010 - Safety/Environment of Care Committee Meetings 1011 - Safety/Environment of Care Committee Agenda - Example 1012 - Safety/Environment of Care Committee Minutes - Example 1013 - Safety/Environment of Care Committee Minutes - Blank 1014 - Safety/Environment of Care Committee Reporting 1015 - Action Summaries Report 1016 - Report to Safety/Environment of Care Committee Form 1017 - Employee Health Report to Safety/Environment of Care Committee Form 1018 - Bimonthly Summary of Patient Incidence Form 1019 - Safety/Environment of Care Committee Report Form 1020 - Quarterly Safety/Environment of Care Committee Report Form 1021 - Safety/Environment of Care Committee Recommendations Form 1022 - Safety/Environment of Care Committee Departmental Action Report Form 1023 - Department Safety/Environment of Care Meeting Form 1024 - Department Safety/Environment of Care Communication Form 1025 - Employee Safety Information 1026 - Incident Report Protocol 1027 - Staff Safety Incident Reports - Illness or Injury 1028 - Staff Safety Incident Report Form 1029 - Supervisor's Report of Accident Form 1030 - Incident Follow-Up Form 1031 - Accident Investigation and Analysis 1032 - Risk Assessment Program - Behavioral Health 1033 - Medical Device Recall Notification 1034 - Manufacturer Recalls and Hazardous Device Notices 1035 - Safety/Environment of Care Committee PI Monitoring and Evaluation Plan 1036 - Safety/Environment of Care Committee PI Trending Sheet 1037 - Safety/Environment of Care Committee PI Outcome Evaluation 1038 - Safety/Environment of Care Committee PI Volume Measures/ Statistics 1039 - Monitoring Activities Summary Format 1040 - Annual Evaluation of the Effectiveness of the Safety Management Program 1041 - Safety Orientation 1042 - Safety Orientation Special Training 1043 - Safety Continuing Education 1044 - Employee Safety Education Report Form 1045 - Body Mechanics Training 1046 - Body Mechanics - Staff Education Handout 1047 - Library Policy

Environment of Care/Hazard Surveillance

1101 - Environment of Care Criteria 1102 - Grounds and Outside Premises Safety Survey Checklist 1103 - Grounds Safety 1104 - Snow Removal 1105 - Physical Environment 1106 - Structural Restraints 1107 - Dining Area/Nutritional Services 1108 - Patient Rooms 1109 - Therapeutic Environment 1110 - Animal Visitation 1111 - Safety Hazard Surveillance 1112 - Hazard Surveillance Detection Survey - Business Office 1113 - Hazard Surveillance Detection Survey - Engineering Department 1114 - Hazard Surveillance Detection Survey - Environmental Services 1115 - Hazard Surveillance Detection Survey - Materials Management 1116 - Hazard Surveillance Detection Survey - Nursing Services 1117 - Hazard Surveillance Detection Survey - Nutritional Services 1118 - Hazard Surveillance Detection Survey - Pharmacy Department 1119 - Hazard Surveillance Detection Survey - Recreational Therapy/Therapeutic Therapy Services 1120 - OSHA Safety Checklist 1121 - Hazard Detection Inspection Reports - Corrective Actions Form 1122 - Staff Safety Questionnaire Form

General Safety

1201 - Patient Safety Plan 1202 - General Hospital Safety and Patient Management - Behavioral Health 1203 - Patient Identification for Clinical Care and Treatment 1204 - Patient Photos for Identification 1205 - Room Assignments and Responsibilities 1206 - Patient Orientation 1207 - Patient Room Safety 1208 - Rounds for Patient Observation 1209 - Patient Clothing 1210 - Siderails and Beds - Safety 1211 - Fall Risk 1212 - Patio Breaks and Activities 1213 - Transport of Involuntary Patients at High-Risk 1214 - Staff Escort for Patient Court Appearance 1215 - Visitors 1216 - Visitor Safety

Department Safety

1301 - Administrative and Business Office Safety 1302 - Engineering Department Safety 1303 - Environmental Services Safety 1304 - Materials Management Department Safety 1305 - Nursing Services Safety 1306 - Nutritional Services Safety 1307 - Pharmacy Department Safety 1308 - Recreational Therapy/Therapeutic Therapy Safety

SECTION 02 - SECURITY MANAGEMENT

2001 - Security Management Plan 2002 - Security Authority 2003 - Security Risk Assessment and Vulnerability Analysis 2004 - Security Risk Assessment and Vulnerability Analysis Form 2005 - Security Risk Assessment and Vulnerability Analysis - Corrective Actions Form 2006 - Facility Protection Form 2007 - Crime Risk Prevention Patrol 2008 - Closed-Circuit Television (CCTV) Monitoring 2009 - Security Code 2010 - Personal Alarm System (PAS)2011 - Key Control 2012 - Security Door Lockout 2013 - Security Incident Report Form 2014 - Theft Incident Report Form 2015 - Incident Log 2016 - Quarterly Report of Security Incidents Form 2017 - Annual Evaluation of the Effectiveness of the Security Management Plan/Program 2018 - Patient Elopement 2019 - Patient Leaving Facility Against Medical Advice 2020 - Patient Initiated Discharge/AMA Intervention Protocol Form 2021 - Leaving Facility Against Medical Advice Form 2022 - Domestic Violence Victims 2023 - Assaultive/Combative Patients - Management of 2024 - Security Measures Involving VIP(s)2025 - Release of Patient Information to News Media 2026 - Forensic (Prisoners) Patients 2027 - Forensic Staff Orientation 2028 - Fact Sheet for Law Enforcement Officials 2029 - Weapons 2030 - Contraband and Restricted Articles 2031 - Valuables 2032 - Patient Property Inventory Form 2033 - Missing Property Form 2034 - Lost and Found Items 2035 - Lost and Found Form 2036 - Room Searches 2037 - Personal Searches 2038 - Metal Detector Use in Searches 2039 - Firearms Prohibition 2040 - Notice to Patients Regarding Firearms Prohibition 2041 - Workplace Violence Prevention Plan 2042 - Workplace Violence Training Outline 2043 - Employee Workplace Violence Assessment Checklist 2044 - Violence Communication Policy 2045 - Recognizing Inappropriate Behavior 2046 - Conduct to Minimize Violence 2047 - Violence Intervention and De-Escalation 2048 - Behavioral Grid - Patient Responses During Escalation Stage 2049 - Violence Incident Report Policy 2050 - Violence Incident Report Form 2051 - Departmental Security Risk Assessment Form 2052 - Cashier Violence Prevention Checklist 2053 - Pharmacy Security 2054 - Visitor Rules and Regulations 2055 - Visitor Application Form 2056 - Removing Hospital Property from Premises 2057 - Duty to Warn and Protect Third Parties in Response to a Threat (Tarasoff Decision)

SECTION 03 - HAZARDOUS MATERIALS AND WASTE MANAGEMENT

3001 - Hazardous Materials and Waste Management Plan 3002 - Hazardous Materials and Waste Management Responsibilities 3003 - Hazardous Materials and Waste - Departmental Management 3004 - Hazardous Materials and Waste - Ordering and Receiving 3005 - Hazardous Materials and Waste - Receiving MSDS 3006 - Hazardous Materials and Waste - Notebook 3007 - How to Read Safety Data Sheets (SDS)3008 - Hazardous Materials and Waste - Storage 3009 - Hazardous Materials and Waste - Waste Disposal 3010 - Hazardous Materials and Waste - Spills 3011 - Facility Floor Plan 3012 - OSHA Hazard Communication Checklist 3013 - Hazardous Chemical Communication Program 3014 - OSHA Hazard Communication Compliance Checklist 3015 - Outside Contractors - Hazardous Chemical Communication Program 3016 - Hazardous Materials and Waste - Training 3017 - Hazard Communication Employee Information and Training Schedule/Log 3018 - New Employee Chemical Inservice Sample Memo 3019 - Chemical Training Record Form 3020 - Hazard Communication Employee Training Record 3021 - Hazardous Materials and Waste - Employee Injury 3022 - Hazardous Materials and Waste - Engineering Department 3023 - Hazardous Materials and Waste - Materials Management 3024 - Hazardous Materials and Waste - Nursing Services 3025 - Hazardous Materials and Waste - Pharmacy Department 3026 - Hazardous Material and Waste - Departmental Reporting Form 3027 - Compressed Gas and Oxygen Use 3028 - Disposal of Sharps 3029 - Asbestos Handling 3030 - Annual Evaluation of the Effectiveness of the Hazardous Materials and Waste Management Plan/Program

SECTION 04 - FIRE/LIFE SAFETY MANAGEMENT

4001 - Life Safety Management Plan 4002 - Life Safety Summaries 4003 - Fire Safety Chain of Command - Key Personnel 4004 - Fire Safety - Responsibilities of Department Managers and Supervisors 4005 - Fire Safety - Staff Responsibilities for General Fire Prevention 4006 - Fire Safety - Hazards 4007 - Materials or Equipment Purchases 4008 - Fire Safety - Smoking Policy 4009 - Types of Fire Extinguishers 4010 - Fire Extinguisher Check 4011 - Fire Extinguisher Log 4012 - Fire Extinguishers - Securing 4013 - Fire Alarm Pull Stations - Securing 4014 - Fire Safety - Building Exits 4015 - Prevention of Fire in an Oxygen Enriched Atmosphere 4016 - Fire Safety - General Instructions 4017 - Fire Safety - Business Office 4018 - Fire Safety - Engineering Department 4019 - Fire Safety - Environmental Services 4020 - Fire Safety - Materials Management 4021 - Fire Safety - Medical Records Department 4022 - Fire Safety - Nursing Services 4023 - Fire Safety - Nutritional Services 4024 - Fire Safety - PBX 4025 - Fire Safety - Pharmacy Department 4026 - Fire Safety - Volunteers, Students, Non-Staff Personnel 4027 - Fire Drill Policy 4028 - Fire Drill Evaluation Form 4029 - Fire Protection Systems - Inspecting, Testing and Maintaining Guidelines 4030 - Fire Alarm System Testing and Inspection 4031 - Fire Alarm System Check Form 4032 - Smoke Detector - Inspection Procedures 4033 - Smoke Detector Test Form 4034 - Location of Fire Safety Smoke Detectors 4035 - Fire Alarm Pull Station Test 4036 - Pull Station Test Form 4037 - Fire Alarm System - Monitoring and Testing 4038 - Fire Alarm Monitor Test Form 4039 - Fire Door Inspection 4040 - Fire Door Inspection Form 4041 - Fire Extinguishing System Check Form 4042 - Sprinkler Drop Test 4043 - Sprinkler Drop Test Form 4044 - Fire Control Valves 4045 - Fire Sprinkler System Repair 4046 - Fire and Smoke Dampers Inspection 4047 - Life Safety Code Compliance 4048 - Interim Life Safety Measures (ILSMs)4049 - Life Safety - New Construction 4050 - Life Safety - Construction Suitability 4051 - Building and Fire Protection Features 4052 - Maintaining the Means of Egress 4053 - Required Fire Protection of Hazardous Areas Form 4054 - Transmission of Fire Alarms 4055 - Automatic Sprinkler Systems - General Inspection Form 4056 - Sprinkler Heads 4057 - Limited Area Sprinkler Systems 4058 - Location of Fire Extinguishers 4059 - Kitchen Hood Automatic Fire Extinguishing System 4060 - Special Building Features 4061 - Holiday Decorations 4062 - Linen and Waste Chutes - General Inspection Form 4063 - Linen and Trash Receptacles 4064 - Portable Space Heaters 4065 - Maintaining Means of Escape 4066 - Maintenance of Vertical Openings, Fire Alarm Systems and Separation of Sleeping Rooms 4067 - Fuel-Fired Heaters 4068 - Maintaining the Integrity of the Means of Egress 4069 - Annual Evaluation of the Effectiveness of the Life Safety/Fire Safety Program

SECTION 05 - UTILITY SYSTEMS MANAGEMENT

5001 - Utility Systems Management Plan 5002 - Plant Operations and Maintenance 5003 - Building Maintenance Program (BMP)5004 - Utility Systems Management - Program Inventory 5005 - Inventory of Utility Systems 5006 - Utility Systems Management Inventory List 5007 - Additions to Utility Systems Management Inventory List 5008 - Deletions from Utility Systems Management Inventory List 5009 - Emergency Numbers List 5010 - Safety Testing and Maintenance of Utility Systems 5011 - Engineering Rounds Log Form 5012 - Preventive Maintenance - Sample 5013 - Maintenance - Boiler and Steam System 5014 - Maintenance - Electrical Distribution System and Generator 5015 - Electrical Distribution Annual Check 5016 - Condition of Electrical Receptacles 5017 - Filter System Log Policy 5018 - Filter Log Form 5019 - Maintenance - HVAC System 5020 - Indoor Air Quality Program 5021 - Air-Handling and Ventilation Systems 5022 - Torn Media Inspection 5023 - Torn Media Inspection Form 5024 - Maintenance - Medical Gas System 5025 - Maintenance - Medical/Surgical Air and Vacuum System 5026 - Piped Medical Gas System Testing 5027 - Maintenance - Vertical and Horizontal Transport System 5028 - Maintenance - Water Distribution and Plumbing System 5029 - Maintenance and Monitoring of Water Systems 5030 - Cooling-Tower Inspection Form 5031 - Water Conditioning 5032 - Water Treatment Test Log 5033 - Utility Systems Shutdown 5034 - Utility Systems Record Drawings 5035 - Electrical Distribution System Shutdown 5036 - Electrical System Shutdown Switches Log 5037 - HVAC System Shutdown 5038 - Emergency Shut-Off of HVAC System Log 5039 - Utility Systems Management - Emergency Shut-Off Labels 5040 - Sample Shut-Off Labels 5041 - Valve Shut-Off Locations - Oxygen Supply 5042 - Guidelines and Procedure for Failure of Essential Equipment 5043 - Utility Systems Failure Chart 5044 - Air Conditioning System - Failure 5045 - Communication System(s) - Failure 5046 - Elevators - Failure 5047 - Elevator Failure - Passenger Evacuation 5048 - Emergency Generator - Failure 5049 - Fire Alarm System - Failure 5050 - High Pressure Boilers - Failure 5051 - HVAC System - Failure 5052 - Medical Air System/Vacuum - Failure 5053 - Medical Gas Oxygen System - Failure 5054 - Natural Gas Supply - Failure 5055 - Nurse Call System - Failure 5056 - Piped Vacuum System and Compressed Air - Failure 5057 - Plumbing System and Flood Procedure - Failure 5058 - Pneumatic Tube System - Failure 5059 - Steam Delivery Boilers - Failure 5060 - Telephone System - Failure 5061 - Vertical Lifts - Failure (Including Dumbwaiters, Cart Lifts)5062 - Water Distribution System - Failure 5063 - Management of Utility System Failure - Electrical Power 5064 - Utility System Failures Log 5065 - Utility Systems Management - Problems, Failures, User Errors 5066 - Utility System Failure/User Error Report Form 5067 - Utility System Failure/User Error Log 5068 - Utility Systems Management - Identified Problems 5069 - Utility Systems Management - Problem Resolution Log 5070 - Quarterly Report To Safety/Environment Of Care Committee - Utility Systems Incidence 5071 - Utility Systems Management - Emergency Power 5072 - Exhibit A - Power Systems Service Agreement 5073 - Utility Systems Management - Emergency Power Maintenance 5074 - Emergency Power Supply System and Stored Emergency Power Supply Systems 5075 - Testing of Emergency Generators 5076 - KVA Rating Specifications 5077 - Generator Test Log 5078 - Battery-Powered Lights for Egress 5079 - Emergency Lighting and Power - Annual Inspections 5080 - Evaluation Form - Emergency Lighting and Power Systems 5081 - Utility Systems Management - User/Maintainer Training 5082 - Engineering Department Training Log 5083 - Utility Systems User/Maintainer Training Log 5084 - Utility Systems Management - Continuing Education 5085 - User Training For Utility Systems Log 5086 - Sample Training Outline - General Facility Knowledge 5087 - Sample Training Outline - Communication Systems 5088 - Sample Training Outline - Hospital Electrical Distribution System 5089 - Sample Training Outline - Emergency Generator 5090 - Sample Training Outline - HVAC System User 5091 - Sample Training Outline - Handling, Storage and Transport of Compressed Gas Cylinders 5092 - Sample Training Outline - Medical Gas 5093 - Sample Training Outline - Medical Gas Alarms Test 5094 - Sample Training Outline - Use of Medical Gas Delivery System 5095 - Sample Training Outline - Breached Medical Gas Lines 5096 - Sample Training Outline - Use of Pumps and Motors 5097 - Sample Training Outline - Steam Boiler 5098 - Sample Training Outline - Underground Storage Tanks 5099 - Sample Training Outline - Use of Water Delivery System 5100 - Contract Service 5101 - Contracted Staff Compliance Checklist 5102 - Supervising and Monitoring Contract Services Checklist 5103 - Outside Contractors Working in the Facility 5104 - Annual Evaluation of the Effectiveness of the Utility Systems Management Plan/Program

SECTION 06 - ELECTRICAL SAFETY

6001 - Electrical Safety 6002 - Equipment Condition and Safety 6003 - Electrical Safety - Distribution Systems 6004 - Electrical Safety - Preventing Overload 6005 - Equipment Safety - Reporting Malfunction 6006 - Lockout/Tagout Procedure 6007 - Sample Lockout/Tagout Labels 6008 - Lockout/Tagout Training 6009 - Outside Vendor Assistance 6010 - Personal Electric Equipment 6011 - Permit for Using Electrical Appliances 6012 - Electrical Extension Cords 6013 - Request For Electrical Extension Cord Form 6014 - Sample Training Outline - Safe Use of Electrical Equipment 6015 - Preventive Maintenance - Defibrillator 6016 - Preventive Maintenance - Electric Beds 6017 - Preventive Maintenance Procedure for Electric Beds Form 6018 - Preventive Maintenance - Electronic Thermometer 6019 - Preventive Maintenance - Ice Dispenser 6020 - Preventive Maintenance - Noninvasive Blood Pressure Monitor 6021 - Preventive Maintenance - Scale 6022 - Preventive Maintenance - Television 6023 - Preventive Maintenance - Wall Suction

SECTION 07 - EMERGENCY MANAGEMENT

7001 - Emergency Management Plan (EMP)7002 - Hospital Command Center (HCC)7003 - Emergency Management Locations Form 7004 - Hospital Floor Plans 7005 - Hazard Vulnerability Analysis (HVA)7006 - Emergency Management - Hazard Vulnerability Analysis Worksheet 7007 - Emergency Management - Delegation of Responsibilities 7008 - General Staff Training 7009 - Emergency Management - Training Record Form 7010 - Community Emergency Telephone Numbers Form 7011 - Communications Processes 7012 - Communication - Internal 7013 - Staff Call-Back Tree 7014 - Emergency Management Call-Back Tree Sample 7015 - Communications - Patients and Families 7016 - Inventory of Resources and Assets 7017 - Utilities - Emergency Management 7018 - Essential Equipment and Supplies - Availability Data Form 7019 - Emergency Water Supply 7020 - Security 7021 - Department Level Command 7022 - Labor Pool 7023 - Staff Support Programs 7024 - Admitting/Operator - Emergency Management 7025 - Engineering Department - Emergency Management 7026 - Environmental Services - Emergency Management 7027 - Human Resources Department - Emergency Management 7028 - Medical Records - Emergency Management 7029 - Nursing Services - Emergency Management 7030 - Nutritional Services - Emergency Management 7031 - Recreational Therapy/Therapeutic Therapy - Emergency Management 7032 - Social Service/Discharge Planning - Emergency Management 7033 - Evacuation 7034 - Patient Transfers - Medical Records 7035 - Red Cross Disaster Information and Resource Center 7036 - Emergency Management Plan - Exercises and Improvement Plans 7037 - Emergency Management Plan Activation - Evaluation Form 7038 - Disruption of Services Procedure 7039 - Disruption of Hospital Services Notification 7040 - Disruption of Services - Electrical 7041 - Disruption of Services - Medical Gas 7042 - Disruption of Services - Natural Gas 7043 - Disruption of Services - Sewage 7044 - Disruption of Services - Water 7045 - Emergency Operations Plan Instructions 7046 - Bomb Threat 7047 - Bomb Threat Room Search 7048 - Bomb Threat Report Form 7049 - Earthquake Response Procedure 7050 - Hostage Situations 7051 - Hurricanes 7052 - Riot or Civil Disturbance Response Plan 7053 - Severe Winter Storms 7054 - Thunderstorms/Tornados 7055 - Annual Evaluation of the Effectiveness of the Emergency Management Plan