Randy Benson Executive Director Rural Healthcare Quality Network

 Survey Tips Gleaned From Critical Access Hospital Fire Marshal Surveys (2000 NFPA Standards)  Fire Drills  Fire Doors  Fire Evacuation  Sprinkler Systems  Fire Retardant Dry Wall  Stairwell Lighting  Annunciator System  Electrical Panels  Miscellaneous

 Fire Drills  Number  Time (Days, Evenings, Nights, Weekends)  Process  Evaluation (All Departments)  Training (Generic Fire Safety), Training (Department Specific Fire Safety), Training (Fire Situation Response – RACE, PASS, etc.)

 Fire and Smoke Doors  Automatic Closure  No Flammable Materials Attached to Doors )e.g. Isolation Signage)  Smoke Barriers (Mouldings, Gaskets)  Sweeps (Nickel Test)  Dust behind the door  No Roller Latches

 Fire Evacuation  Clutter in Hallways  Routes Posted  Staff Training  ‘EXIT’ Signage  Drills (Staff Competency Training)

 Sprinkler Systems  Type of Sprinkler Heads (age, etc.)  Paint on Sprinkler Heads  Testing  Additions or Modifications

 Fire Retardant Dry Wall  Know the NFPA Standards  Building Abuts a Business Structure or Old Part of Hospital (No Longer In Use)  Documentation

 Stairwell Lighting  Where  Type  Testing  Monthly  Annually (Battery Life)

 Annunciator System  Annual Inspection Documentation  Heard Everywhere  Seen Everywhere  Drill Evaluation

 Electrical Panels  Locked  Properly Labeled  Levels of Service Identified  Inspections Up To Date

 Miscellaneous  Kitchen Grill Fire Suppression System  Flammable Materials In Patient Rooms  Cubicle Curtains  Bed Spreads  Chair Upholstery  PHI Paper Storage  Flammable Gas Storage

 Miscellaneous  Miscellaneous (cont.)  Portable Heaters  Monthly Fire Extinguisher Checks  Ventilation System Shutdown During Fires  Fire Proof Storage Areas for Flammable Materials

QUESTIONS

Randy Benson Executive Director Rural Healthcare Quality Network