Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
PREPARED BY:
FACILITY NAME:
ADDRESS:
PHONE:
I.
CITY, ZIP, STATE:
FAX:
E-MAIL:
HOUSEKEEPING/PHYSICAL HAZARDS
Housekeeping/Physical Hazards: All facilities should be maintained in consideration of the following points:
YES
NO
N/A
1. Good housekeeping practices are maintained throughout the
facility/campus to promote a safe and healthy environment
2. All vents, registers, air handling screens, filters and diffusers are
cleaned regularly to help eliminate potential respiratory hazards
3. Lint traps in clothes dryers are cleaned regularly and the flexible
exhaust vent is properly secured to the machine
4. Walking surfaces are regularly cleaned and carpeting is regularly
vacuumed to help eliminate slippery surfaces and subtle slip/trip/fall
hazards
Page 1 of 30
COMMENTS
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
I.
HOUSEKEEPING/PHYSICAL HAZARDS (CONTINUED)
Housekeeping/Physical Hazards: All facilities should be maintained in consideration of the following points:
5. All spills and standing water on interior surfaces are immediately
cleaned up to help eliminate slip/fall hazards
6. All leaks are identified and repaired in a timely manner to help
eliminate long term damage as well as eliminate slip/fall hazards
7. Gutter downspouts are arranged/maintained in a position so they do
not cause standing water in walking paths or outside of exit
discharge points from a building
8. All snow and ice removal is completed in a timely manner on all
aspects of the property, including areas around exit discharge doors
that may not be normally utilized for entering the building but may
be required for emergency evacuation
9. Snow is properly removed from all fire lanes
10. Snow plowing does not compromise access to fire hydrants, sprinkler
and standpipe connections on exterior of property
11. All tables, counters, chairs and other similar surfaces are regularly
cleaned to eliminate any slippery surfaces
12. All walking paths and surfaces (both interior and exterior) are
continuously monitored for trip hazards, and such hazards are
immediately eliminated when identified
13. All guardrails and other railings are stable and properly
anchored/secured
Page 2 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
I.
HOUSEKEEPING/PHYSICAL HAZARDS (CONTINUED)
Housekeeping/Physical Hazards: All facilities should be maintained in consideration of the following points:
14. All non-slip surfaces or similar products (surface coverings) that may
be affixed to stairs or floors are stable and properly secured
15. Wooden components of stairs, ramps and railings are regularly
inspected for evidence of rotting, splintering and stability
16. Concrete surfaces are regularly inspected for signs of heaving,
buckling, cracking or other conditions that may cause a trip/fall
hazard, and proper repairs are initiated when identified
17. All clutter and excessive/non-essential items in storage rooms are
eliminated
18. All storage is maintained in a neat and organized manner, and
adequate aisles are established in storage spaces for safety and
egress purposes
19. All heavy storage items are kept on lower shelves rather than upper
shelves
20. Large items on shelves, carts, tables, platforms, etc. are properly
anchored to avoid damage or personal injury
21. Wheels on all carts and similar items are regularly inspected for
damage and stability to prevent tipping
22. Storage in unauthorized locations, e.g., hallways, stairwells assembly
rooms, classrooms, electrical rooms, mechanical rooms, etc., is
eliminated as such storage may represent an increased fire load and
safety code violation
Page 3 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
I.
HOUSEKEEPING/PHYSICAL HAZARDS (CONTINUED)
Housekeeping/Physical Hazards: All facilities should be maintained in consideration of the following points:
23. All mats, carpets, throw rugs, etc. are properly secured and properly
utilized
24. Cords or similar items running underneath mats, carpets, throw rugs,
etc. are eliminated
25. Cords or similar items running under, over or through doors,
windows or other openings in building construction are eliminated
26. Low hanging items (decorations, plants, etc.) that are not part of
building design or construction are eliminated
27. All overhead obstructions/hazards and grade-level stationary trip
hazards that cannot be eliminated are properly marked with
appropriate warning signs and markings
28. Windows and vision panels in doors are maintained in a condition
that will not obstruct view and cause a potential hazard when
occupants are passing through the doors
29. All broken glass is immediately and properly repaired. Tape or other
temporary/unsafe methods to cover cracks in glass or mirrors is not
utilized
30. All surfaces are constantly monitored for sharp or rough edges and
repaired immediately when identified
Page 4 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
I.
HOUSEKEEPING/PHYSICAL HAZARDS (CONTINUED)
Housekeeping/Physical Hazards: All facilities should be maintained in consideration of the following points:
31. All machine guards and panel covers are secured in place on all
pieces of equipment at all times, and appropriate eye protection is
available and utilized
32. All pressurized cylinders (oxygen, helium, etc.) are properly secured
on a cart or in a tank corral or are securely chained to a wall or
column to prevent accidental tipping
33. Safety caps are kept on pressurized cylinders to protect valves
34. Lock-out/tag-out procedure is utilized, and appropriate supplies are
provided as required
35. All electrical panels and inspection covers on equipment accessible
to the public are properly secured and locked
36. Eye washing stations are installed and maintained in all appropriate
locations. Regularly check fluids for expiration dates
37. Bumper protection is provided around utilities (meters, valves,
transformers, control panels, etc.) to help eliminate potential
damage from blunt force
38. Heat producing devices, such as hot water radiators, are properly
shielded to eliminate potential burn injuries
39. Utility shut-off valves, levers and switches are properly marked for
easy identification and emergency shut-down, if required
40. All product safety information, including instructions, alerts, recalls,
bulletins, warnings, etc., are thoroughly reviewed, maintained on file
and distributed to all appropriate parties (staff, volunteers, etc.)
Page 5 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
1. A comprehensive policy prohibiting the use of unattended candles or
open flame devices is developed and enforced
2. A comprehensive policy prohibiting the use of unattended hot
plates, warmers, aroma producing devices and other devices that
may overheat and cause a fire is developed and enforced
3. A comprehensive policy prohibiting the use of space heaters or
similar heat producing devices (heat cords, propane heaters, etc.) is
developed and enforced
4. “No Smoking” policy is being enforced. Continuously survey interior
of buildings for evidence of unauthorized smoking to help ensure
compliance
5. Matches and lighters needed for the operation are not accessible to
children
6. All extension cords are eliminated from all buildings with the
exception of approved outlet strips equipped with built-in circuit
breaker/surge protection
7. Inspections are regularly conducted to identify and eliminate overloaded electrical sockets and the use of unapproved socket adapters
8. Approved ground fault circuit interrupter (GFCI) outlets are provided
in all locations within six feet (6’) of a water or liquid source (sink,
spigot, slop sink, commercial coffee pot, fish tank, water cooler, etc.)
Page 6 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
9. Cords to all electrical appliances and equipment are regularly
inspected for damage and repaired as needed
10. All repairs to electrical equipment including cords are completed
only by qualified technicians or electricians
11. All circuit breaker boxes and fuse boxes are regularly inspected to
ensure that they do not show signs of overheating, and all open slots
are equipped with an approved breaker, blank or fuse
12. At least 36 inches (36”) of clearance is provided around electrical and
mechanical equipment
13. Provide markings (yellow/black striped tape or paint, etc.) on the
floor around the equipment defining the clearance zone if storage is
near electrical and mechanical equipment
14. All unsafe and “home-made” wiring arrangements are eliminated
from the operation
15. Buildings are regularly checked for evidence of open wiring, missing
outlet covers and missing switch covers, which are repaired or
replaced immediately upon identification
16. All broken or cracked electrical outlets, plates and switch covers are
replaced upon identification
Page 7 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
17. All missing junction box covers are replaced when identified
18. Appropriately sized light bulbs are used in all fixtures; eliminate high
wattage/high heat producing bulbs
19. Approved protective cage or cover is in place over all torch-style
lamps with halogen bulbs, as heat from halogen bulbs represents a
fire hazard
20. All electric motors are maintained in a clean, dust-free condition to
eliminate a potential fire hazard caused by excessive debris or
overheating due to the presence of foreign material on the motor
21. All garbage cans and dumpsters are sufficiently away from the
building so that fire cannot communicate into the structure if they
were to catch fire
22. Trash or refuse is not allowed to build up anywhere inside of the
building or around garbage cans and dumpsters on the exterior of
the building
23. All hazardous materials including combustible and flammable liquids
are properly stored in approved safety cans
24. All flammable and combustible liquids are properly stored in
approved flammable liquids lockers, and the doors to the lockers are
kept closed when they are not in use
Page 8 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
25. Storage areas are regularly checked for hazardous materials in
unapproved locations
26. All flammable and combustible liquids are properly separated from
all potential ignition sources
27. Equipment like snow blowers, lawn mowers, wheeled power
blowers and other pieces of equipment with small engines are not
allowed inside of buildings in hallways and stairwells or other
unapproved locations as the items contain flammable liquids and
represent a hazard
28. Material Safety Data Sheets (MSDS) on all required materials are
maintained on file
29. Employees are provided with access to MSDS in accordance with
requirements under “Right-to-Know”
30. The facility’s MSDS book (master as well as all other copies) is
reviewed and updated regularly
31. Copies of appropriate MSDS are accessible at all potential points of
exposure (housekeeping storage, garage, kitchen, lab, etc.)
Page 9 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
32. Chemicals in labs or storage areas that react adversely with others
are properly separated and not placed above or below other
chemicals that when mixed together can cause a negative reaction
33. All storage within the facility is regularly checked to ensure that it
complies with the eighteen inch (18”) clearance rule if the building is
equipped with a fire sprinkler system
34. Storage is immediately rearranged when it exceeds the maximum
height to provide 18 inches (18”) of clearance under all fire sprinkler
heads
35. A bold stripe (tape or paint) is provided in all storage rooms defining
maximum storage height
36. Storage items do not obstruct access to electrical or mechanical
equipment including fire protection system components (alarm
panels, fire pump, sprinkler controls, etc.)
37. All fire protection system components are maintained, tested and
serviced in accordance with manufacturer’s guidelines and all
applicable codes and standards
38. All fire protection system control valves are clearly marked or tagged
and properly secured and/or supervised (tamper switch, chains,
locks, etc.) to ensure proper operation and prevent tampering
39. The area around system components is free and clear of
obstructions, and a clearance zone of at least 36 inches (36”) is
provided around control valves, control boxes, compressors, risers,
fire pumps and other operating devices
Page 10 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
40. All system gauges and associated piping (exposed risers, branch
lines, etc.) are regularly visually inspected for signs of leaks or
damage
41. Fire sprinkler heads and fire alarm system detectors (smoke and
heat) are regularly inspected for signs of damage, paint, tape or
other foreign matter, especially after remodeling/painting in a space
within the building
42. The required spare fire sprinkler head box is regularly inspected to
ensure there is a supply of spare heads as well as required sprinkler
wrench
43. A churn test of the fire pump is conducted weekly and initiated by a
drop in pressure, subsequently allowing the pump to run for five
minutes before restoring the pump back to its normal, automatic
position
44. Fire pump is tested annually with a full flow test to measure water
flow and pressure
45. All test data and inspection tags are maintained on file and properly
displayed as required
46. Doors to the fire sprinkler pump/control room and fire alarm control
panel room are properly marked to provide easy identification to
emergency responders
Page 11 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
47. Items including clothes hangers and decorations (streamers, art
work, banners, etc.) are not allowed to be hung from sprinkler heads
or fire alarm system components (ceiling mounted detectors,
horn/strobe devices, etc.)
48. All fire alarm system components (pull stations, detectors, horns,
etc.) are free and clear of any obstructions that may compromise
operation of the system or access to a device (example: furniture
obstructing access to pull station)
49. Proper keys or tools are accessible for resetting fire alarm pull
stations
50. Approved carbon monoxide detectors are installed in appropriate
locations in buildings where gas-fired equipment is present and near
all sleeping areas as required by state and local codes
51. Exterior components of fire protection systems, such as the fire
sprinkler system’s water flow gong, are regularly checked for foreign
material like a bird’s nest or other similar material that may
compromise operation
52. Exterior fire department connections are checked regularly for
evidence of damage or items stuck inside the piping
53. Covers are properly secured on exterior fire department connections
54. Landscaping items (bushes, trees, tall grass, plants, etc.) are not
obstructing access to exterior fire department connections or fire
hydrants on the property
Page 12 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
55. All fire extinguishers are visually checked on a weekly basis
56. Areas that are not equipped with a fire extinguisher are identified,
and additional extinguishers are installed where appropriate
57. Visual inspections of fire extinguishers are documented on a log or
on the back of the inspection tag attached to the fire extinguisher,
citing the date the extinguisher was inspected
58. Fire extinguishers have a current inspection tag indicating that they
have been tested and serviced annually by a qualified technician in
accordance with code requirements
59. All fire extinguishers are free and clear of any obstructions that may
compromise access in an emergency
60. All fire extinguishers are hanging on their mounts or stored in an
approved cabinet rather than placed on a floor or table
61. The appropriate type of fire extinguisher is installed in specific areas
based on the appropriate fire classification (A, B, C or combination
style, and K- commercial kitchen)
62. The commercial kitchen fixed fire extinguishment systems (Ansul,
UL300, high pressure water spray, etc.) have a current inspection tag
indicating that they have been tested and serviced annually by a
qualified technician in accordance with code requirements
Page 13 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
63. The facility’s fire department lock box (Knox Box, Supra, etc.)
contains keys that are applicable and up-to-date
64. The means of egress (exit access, exit and exit discharge) is
maintained in a condition that is free of all obstructions
65. All locks on doors are compliant with applicable codes and standards
and will not prohibit egress from an area during an emergency
66. The means of egress is not being used for storage
67. The means of egress is not restricted by the presence of
unauthorized items like tables, chairs, desks, cabinets, etc.
68. Work stations are not set up in the means of egress
69. A minimum of 48 inches (48”) of clear exit width is maintained within
the means of egress at all times
70. Combustible items like decorations in hallways do not create
hazards that increase the fire load in the means of egress or create
potential obstructions should the material catch fire
Page 14 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
71. Items are removed from receiving doors/areas in a timely manner so
items do not build up and compromise the means of egress or
provide an unnecessary fire load in a space not designated as a
storage room
72. Adequate lighting is maintained within the means of egress
73. Emergency lighting units are tested regularly to ensure operation
74. Inoperable emergency lighting units are repaired immediately when
identified
75. Exit signs are checked regularly to ensure proper illumination
76. Inoperable exit signs units are repaired immediately when identified
77. Batteries are tested on emergency lighting units and exit signs on a
weekly basis
78. A log is established to document all weekly tests/checks of life safety
equipment
79. The lamps on emergency lighting units are properly aligned to
illuminate the means of egress during a power failure. Adjust lamps
where needed so they are pointing in the proper direction
Page 15 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
80. Periodically release/close and inspect operation of all fire/smoke
doors held open by the fire alarm system
81. There are no obstructions in the paths of the fire/smoke doors that
may prohibit proper operation/closure
82. Proper labels are displayed on fire/smoke doors and not removed or
painted over
83. All unapproved kick stands, wedges and hold-open devices propping
open doors that are required to be in the closed position are
eliminated from the building
84. All fire-rated assemblies (walls, ceilings, partitions, etc.) are
periodically checked for unapproved penetrations that will
compromise the assembly’s fire resistance rating
85. All unapproved penetrations in fire-rated assemblies are
repaired/sealed with approved fire caulk or other approved fireresistant material to maintain required separation
86. All work completed by sub-contractors, such as computer or
telecommunications technicians, is immediately inspected to ensure
that all penetrations created during installation of system
components are properly sealed before jobs are finished
87. “In Case of Fire, Do Not Use Elevator” signs or similar placards are
posted next to all elevators
Page 16 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
II.
FIRE AND LIFE SAFETY CONSIDERATIONS (CONTINUED)
Fire and Life Safety Considerations: All facilities should be maintained in consideration of the following points:
88. Evacuation diagrams are provided in strategic locations within
buildings depicting primary and secondary escape routes and include
locations of fire extinguishers and pull stations as well as locations of
severe weather shelters
89. Live decorations (trees, bushes wreaths, etc.) that have been cut and
are in the process of dying/drying are prohibited from all buildings as
they represent a fire hazard
90. All electrical decorations (light strands, figures, etc.) are thoroughly
inspected prior to use and installation
91. Damaged light strands are discarded when repairing them appears
to be complex
Page 17 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
III.
SECURITY CONSIDERATIONS
Security Considerations: All facilities should be maintained in consideration of the following points:
1. All employees are continuously reminded to always consider the
security of the facility when making decisions impacting operations
2. A high regard for security is promoted, and staff members are
advised to question the purpose of all unknown parties within a
building in a polite yet firm manner
3. Staff members are required to immediately report any suspicious or
criminal activity to facility administration or law enforcement if
required
4. A supervisory/security presence is provided for all activities requiring
additional security measures, especially when activities involve
visitors not typically associated with the facility
5. All interior and exterior doors and associated hardware are
periodically inspected to ensure that they properly close and lock in
accordance with designated function and design
6. All windows and associated hardware are periodically inspected to
ensure that they properly close and lock in accordance with
designated function and design
7. The exterior of all buildings is periodically checked for signs of forced
entry or potentially unprotected access points to the interior of the
building (screens, louvers, air intake grill, etc.)
8. All unnecessary ground clutter/refuse (large rocks, bricks, tree limbs,
etc.) that may be used to damage a building by vandals is eliminated
Page 18 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
III.
SECURITY CONSIDERATIONS (CONTINUED)
Security Considerations: All facilities should be maintained in consideration of the following points:
9. All elements of the property are continuously checked for signs of
graffiti/vandalism and immediately removed/repaired upon
identification
10. If security alarm system is present, ensure that it is properly utilized
at all times
11. If access control system is present, ensure that it is properly utilized
at all times
12. If security surveillance camera system is present, ensure that it is
properly utilized at all times
13. All interior and exterior lighting is continuously evaluated, and
broken, dead or missing bulbs are replaced as soon as identified
14. All interior and exterior lighting arrangements are periodically
checked for dark corners or shadows and provide appropriate
illumination to eliminate potential hiding places
15. The exterior of the building is equipped with appropriate security
lighting
16. All bushes and shrubs are maintained in a condition where they
cannot be used as potential hiding places
III.
SECURITY CONSIDERATIONS (CONTINUED)
Security Considerations: All facilities should be maintained in consideration of the following points:
Page 19 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
17. All trees are maintained in a condition where they cannot be used to
climb onto roofs or as access to upper floor windows
18. Gutters or other similar elements of building construction cannot be
used to climb onto roof or as access to upper floor windows
19. The facility’s visitor sign-in policy/program is properly utilized at all
times
20. The facility’s visitor badge policy/program is properly utilized at all
times
21. Staff members properly wear and display identification badges
22. A single controlled access point into buildings is maintained for
visitors
23. Building occupants do not prop open exterior doors for convenience
purposes
24. Receiving doors and docks are properly secured when not in use; do
not leave receiving doors unlocked for delivery services
25. All security fences on the property are periodically checked for
breaches and damage
Page 20 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
III.
SECURITY CONSIDERATIONS (CONTINUED)
Security Considerations: All facilities should be maintained in consideration of the following points:
26. Access doors to administrative offices and areas containing
confidential documents/sensitive information are kept locked when
not in use
27. Access doors to areas in the building containing high value items like
computers are kept locked when not in use
28. Access doors to areas in the building containing potentially hazardous
materials (labs, workshops, etc.) are kept locked when not in use
29. All closets, storage rooms, mechanical rooms, electrical rooms, etc.
are locked when not in use
30. All publicly accessible electrical boxes and similar control panels are
locked when not in use to avoid tampering
31. An inventory list and schedule of all equipment is maintained and
updated regularly
32. Photographs of high value furniture, equipment, unique items, etc.
are taken and maintained on file
33. All property is marked regardless of dollar value, associating the
property to the facility
34. Cash supplies within the building are secured in an appropriate
location
Page 21 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
III.
SECURITY CONSIDERATIONS (CONTINUED)
Security Considerations: All facilities should be maintained in consideration of the following points:
35. Teams responsible for counting cash (donations, revenue, fees, etc.)
are periodically rotated
36. Bank deposit times and travel routes are rotated and varied to
eliminate predictability
37. An accountability system exists to track all keys distributed for the
facility
38. Locks are changed when security concerns warrant
Page 22 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
IV.
DISASTER PREPAREDNESS/EMERGENCY MANAGEMENT
Disaster Preparedness/Emergency Management: All facilities should be maintained in consideration of the following points:
1. The facility has a disaster preparedness committee
2. The facility has established a disaster preparedness program
3. A formal Hazard Vulnerability Assessment (HVA) has been completed
to determine the types of threats and perils that may impact the
facility
4. The facility has developed written emergency plans and procedures
consistent with the HVA
5. Written emergency planning utilizes an “All Hazards” approach and
is not limited to common events only (fire, flood, power failure, etc.)
6. The facility has established emergency plans and procedures for the
following common emergencies:

Fire/explosion

Power Failure

Flood

Severe weather (thunderstorm, tornado, etc.)

Extreme weather (prolonged heat or cold)

Earthquake

Mechanical/equipment failure (HVAC, etc.)

Bomb threat

Pandemic

Civil disturbance

Intruder

Terrorism

Any threats unique to the facility identified in the HVA
Page 23 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
IV.
DISASTER PREPAREDNESS/EMERGENCY MANAGEMENT (CONTINUED)
Disaster Preparedness/Emergency Management: All facilities should be maintained in consideration of the following points:
7. Written emergency procedures are concise, easy to read and provide
essential information to properly handle a crisis or disaster situation
8. Written emergency plans and disaster manuals are accessible to
employees at all times and not kept locked behind closed doors
9. Written emergency plans, policies and procedures are reviewed and
updated on at least an annual basis
10. Written emergency plans, policies and procedures are reviewed and
updated whenever significant changes happen within the
organization (downsizing, expansion, personnel changes, etc.)
11. Copies of written emergency plans, policies and procedures are
maintained in a secure off-site location that is sufficiently away from
the facility but will be accessible during a crisis or disaster situation
12. The facility’s emergency procedures utilize an approved
management model like the Nursing Home Incident Command
System (NHICS)
13. An Incident Commander or person in charge is established when
handling all crisis or disaster situations
14. A Nursing Home Command Center (NHCC) has been established in
advance of a crisis or disaster situation where key staff
members/decision makers will meet to manage an incident
15. An alternate NHCC has been established should the main command
post be inaccessible
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Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
IV.
DISASTER PREPAREDNESS/EMERGENCY MANAGEMENT (CONTINUED)
Disaster Preparedness/Emergency Management: All facilities should be maintained in consideration of the following points:
16. A specific chain-of-command has been established in advance of a
crisis or disaster
17. A specific succession of command has been established in advance
of a crisis or disaster
18. Key decision makers are familiar with all emergency procedures
19. Regular training is provided on emergency procedures to all levels of
staff and volunteers
20. Drills are periodically conducted, including tabletop exercises to
practice incident management
21. A formal survey has been completed to determine the appropriate
amounts of food and water needed on-site for use during a disaster
scenario requiring building occupants to shelter in place
22. A sufficient supply of emergency food (non-perishables) and water is
maintained in accordance with Federal Emergency Management
Agency (FEMA) guidelines
23. Manual can openers (non-electric) and other utensils needed to
prepare food are available
24. One gallon of water per person per day for a minimum of three days
is available as part of the emergency supply (three gallons/person)
25. Emergency supplies are rotated in accordance with expiration dates
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Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
IV.
DISASTER PREPAREDNESS/EMERGENCY MANAGEMENT (CONTINUED)
Disaster Preparedness/Emergency Management: All facilities should be maintained in consideration of the following points:
26. A supply of flashlights, lanterns and other products that can provide
illumination during a power failure is maintained
27. A supply of spare batteries is maintained and periodically rotated to
ensure viability
28. First-aid kits, blankets, pillows and other supplies are maintained
that may be beneficial during a disaster
29. Areas within buildings that are suitable for taking shelter during a
severe weather emergency have been identified
30. Designated shelter areas in buildings have been identified with
approved signs or diagrams defining safe areas to take cover
31. Evacuation maps are provided throughout the building depicting
primary and secondary means of egress
32. The location of pull stations and fire extinguishers are shown on the
evacuation maps
33. The location of internal shelter areas are shown on the evacuation
maps
34. Designated meeting areas have been established on the outside of
buildings to reassemble occupants following building evacuation
35. A head count is completed once an evacuation has occurred
36. Agreements have been established with transportation providers
(bus service, livery service, etc.) in case community resources are not
available to facilitate evacuation during a major disaster
Page 26 of 30
Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
IV.
DISASTER PREPAREDNESS/EMERGENCY MANAGEMENT (CONTINUED)
Disaster Preparedness/Emergency Management: All facilities should be maintained in consideration of the following points:
37. Agreements have been established with other facilities in the
immediate area to provide shelter for evacuees
38. Agreements have been established with other facilities outside of
the immediate area to provide shelter for evacuees
39. Identify multiple methods of communicating in the event of a
disaster (land lines, cell phones, portable radios, etc.)
40. A cell phone is maintained on premises with an area code that is not
from the region for emergency purposes
41. A current list of phone numbers for all staff members is maintained
and easily accessible for emergency purposes
42. A current list of phone numbers for all suppliers and essential
services is maintained and easily accessible for emergency purposes
43. Phone lists are updated on a regular basis
44. A site security plan has been developed to help protect assets during
a crisis or disaster
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Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
V.
CONTINUITY OF OPERATIONS PLANNING
Continuity of Operations Planning: All facilities should be maintained in consideration of the following points:
1. A Continuity of Operations Planning (COOP) or Business Continuity
Planning (BCP) committee has been established to help ensure the
organization can maintain viability during a crisis or disaster
2. A formal COOP or BCP procedure has been developed
3. The COOP template available from the Federal Emergency
Management Agency (FEMA) has been utilized as a guide to develop
a comprehensive plan
4. The plan identifies essential services that the organization must
provide and maintain through a crisis or disaster
5. Essential services have been prioritized and identified how they will
be provided with reduced staffing (minimal staffing available during
a crisis or disaster)
6. The chain of command and succession of command is clearly
identified for purpose of business and operational continuity
7. Appropriate security and protection is provided with all information
technology (IT) programs
8. Passwords are reviewed and changed regularly
9. Redundancy has been established within IT to ensure that programs
and files are duplicated and can be recovered
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Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
V.
CONTINUITY OF OPERATIONS PLANNING (CONTINUED)
Continuity of Operations Planning: All facilities should be maintained in consideration of the following points:
10. Hard copies of essential written documents are maintained as a
back-up
11. Hard copy back-up documents are not kept in the same location as
originals
12. All computer files are regularly backed up
13. Back-up disks are not kept in the same location as original copies and
hard drives/servers
14. Secure off-site storage is provided for all documents and electronic
files that are backed up
15. An alternate method of writing checks for payroll and other
expenses is maintained if electronic or automatic systems are
compromised
16. A reasonable amount of cash is maintained in a secure location on
premises for emergency purposes
17. Access to critical account numbers and insurance policy numbers is
provided
18. A plan to systematically re-engage or re-activate programs and
services is pre-established following an adverse event
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Arizona Health Care Association
DISASTER PLANNING AND EMERGENCY MANAGEMENT GUIDE
DISASTER PREPAREDNESS RISK MANAGEMENT CHECKLIST
NOTES
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