The Behavioral Health Environment Of Care Manual is part of MCN Healthcare’s ellucid® Policy Library. MCN Healthcare is the health care industry’s leading provider of TJC (formerly JCAHO) accreditation tools and CMS accreditation help, consisting of policy and procedure templates, forms, competencies and other compliance tools. MCN’s policy and procedure manuals are used in more than 25,000 healthcare organizations throughout the world to help with compliance, accreditation, and health care quality improvement.

All customizable policies, procedures, forms and compliance tools are provided as templates in Microsoft Word format. MCN’s policy and procedure library consists of 87 policy and procedure manuals and more than 18,000 compliance tools. This is the most comprehensive collection of customizable policy templates, policies, procedures, forms, competencies, job descriptions, and performance evaluations available anywhere—all kept up to date with the latest standards from CMS, Joint Commission, FDA, HIPAA, OSHA, ACHC, AAAHC, USP, and utilizing standards of practice from ANA, AORN, ENA, and more.

SECTION I - SAFETY MANAGEMENT

Program Organization

Policy and Procedure Manual Annual Review and Approval

Safety Committee Organizational Chart (Sample)

Safety Management Plan

Responsibilities

Policy Statement - Safety Management

Authority

Letter of Safety Officer Appointment

Position Description/Performance Evaluation - Safety Officer

Performance Evaluation - Age-Related Competency - Safety Officer

Annual Competency Clinical Skills Assessment - Safety Officer

Library Policy

Reporting Policy

Environment of Care Criteria

Safety Committee Meetings

Safety Committee Agenda

Safety Committee Minutes Form (Sample)

Safety Committee Minutes Form (Blank)

Safety Committee Reporting

Action Summaries Report

Report to Safety Committee Form

Employee Health Report to Safety Committee Form

Bimonthly Summary of Patient Incidence Form

Safety Committee Report Form

Quarterly Safety Committee Report Form

Safety Committee Recommendations Form

Safety Committee Departmental Action Reporting Form

Departmental Safety Meeting Form

Departmental Safety Communication Form

Risk Assessment Program

Incident Report Protocol

Safety Incident Report Form

Incident Follow-Up Form

Supervisor's Report of Accident Form

Incident Reporting Staff Questionnaire

Incident Reports Illness or Injury

Work Related Back Injury

Accident Investigation and Analysis

Hazard Surveillance

Safety Hazard Surveillance

Hazard Surveillance Detection Surveys:

Business Office

Dietary Department/Service

Engineering Department/Service

Environmental Services

Materials Management

Nursing Services

Pharmacy

Recreational Therapy and Therapeutic Therapy/Services

Departmental Hazards

Hazard Detection Inspection Reports - Corrective Actions

OSHA Safety Checklist

General Safety

Exposure Control Plan - Engineered Sharps Injury

Sharps Injury Log

Employee Infection Control

General Facility Safety and Patient Management

Visitors

Visitor Safety

Patient Orientation

Patient Identification

Patient Photos for Identification

Patient Room Safety

Rounds for Patient Observation

Room Assignments and Responsibilities

Clothing Belonging to Patients

Patient Safety Plan

Transport of Involuntary Patients at High Risk

Staff Escort for Patient Court Appearance

Protocol for Patio Breaks and Activities

Fall Risk

Initial Screen for Fall Precautions Form

Fall Prevention

Fall Precaution Intervention Form

Post Fall Assessment Form

Medication Error - Medication Precautions

Beds and Side Rails

Unlocked Time Out for Behavior Management

Assessment for Suicidality

Suicide Precautions

Education and Training

Employee Safety Information

Safety Orientation

Registry Personnel

Body Mechanics

Safety Orientation Special Training

Safety Continuing Education

Employee Safety Education Report

Staff Safety Questionnaire

Performance Improvement

Monitoring Activities Summary Format

Environment of Care Performance Measures

Environment of Care Trending Sheet

Departmental Safety

Administrative and Business Office Safety

Dietary Services Safety

Engineering Department/Service Safety

Environmental Services Safety

Buildings and Grounds

Grounds Safety

Grounds and Outside Premises Safety Survey Checklist

Snow Removal

Materials Management Safety

Nursing Services Safety

Pharmacy Department Safety

Recreational Therapy, Therapeutic Therapy Safety

Annual Evaluation of the Effectiveness of the Safety Management Program

SECTION II - SECURITY MANAGEMENT

Security Management Plan

Security Authority

Vulnerability Report

Security Crime Vulnerability Inspection Report Form

Security Crime Vulnerability Inspection Report Corrective Actions

Crime Risk Prevention Patrol

Security Code

Elopement

Patient Leaving Facility Against Medical Advice

Patient Initiated Discharge/AMA Intervention Protocol Form

Leaving Facility Against Medical Advice Form

Closed-Circuit Television Monitoring (CCTV)

Key Control

Removing Facility Property From Premises

Security Door Lockout

Valuables

Contraband and Restricted Articles

Patient Property Inventory Form

Missing Property Form

Lost and Found Items

Lost and Found Form

Security Incident Report Form

Theft Incident Report Form

Incident Log

Quarterly Report of Security Incidents Form

Visitor Rules and Regulations

Visitor Application Form

Security Measures Involving VIP(s)

Release of Patient Information to News Media

Forensic Patient

Forensic Staff

Fact Sheet for Law Enforcement Officials

Weapons

Firearms Prohibition

Notice to Patients Regarding Firearms Prohibition

Room Searches

Personal Searches

Metal Detector Use in Searches

Duty to Warn and Protect Third Parties in Response to a Threat (Tarasoff Decision)

Departmental Security Risk Assessment Form

Pharmacy Access

Pharmacy Security

Cashier Violence Prevention Checklist

Facility Protection Form

Hostage Situations

Workplace Violence Prevention Plan

Workplace Violence Training Outline

Employee Workplace Violence Checklist

Violence Communication Policy

Domestic Violence Victims

Recognizing Inappropriate Behavior

Conduct to Minimize Violence

Management of Assaultive/Combative Patients

Violence Intervention and De-Escalation

Behavioral Grid - Patient Responses During Escalation Stage

Violence Incident Report Policy

Violence Incident Report Form

Annual Evaluation of the Effectiveness of the Security Management Program

SECTION III - HAZARDOUS MATERIALS AND WASTE MANAGEMENT

Hazardous Materials and Waste Management Plan

Hazardous Materials and Waste - Responsibilities

Hazardous Materials and Waste - Departmental Management

Hazardous Materials and Waste - Notebook

How to Read MSDS

Hazardous Materials and Waste - Ordering and Receiving

Hazardous Materials and Waste - Receiving MSDS

Hazardous Materials and Waste - Storage

Hazardous Materials and Waste - Waste Disposal

Hazardous Materials and Waste - Spills

Facility Floor Plan

Hazardous Chemical Communication Program

Outside Contractors Hazard Communications Program

OSHA Hazard Communication Checklist

Hazardous Materials and Waste - Training

Hazard Communication - Employee Information and Training Schedule/Log

New Employee Chemical Inservice Sample Memo

Chemical Training Record

Hazard Communication Employee Training Record

Ethylene Oxide Monitoring, Employee Training Program and Emergency Response

Hazardous Materials and Waste - Employee Injury

Hazardous Material and Waste:

Engineering Department

Nursing Department/Service

Pharmaceutical Department

Materials Management

Hazardous Material and Waste - Departmental Reporting Form

Compressed Gas and Oxygen Use

Disposal of Sharps

Mercury Handling

Asbestos Handling

OSHA Hazard Communication Compliance

Annual Evaluation of the Effectiveness of the Hazardous Materials and Waste Management Program

SECTION IV - EMERGENCY MANAGEMENT

Emergency Management Plan

Hazard Vulnerability Analysis

Emergency Management - Hazard Vulnerability Analysis Worksheet

Emergency Management Locations

Facility Floor Plans

Community Emergency Telephone Numbers Form

Emergency Management - Delegation of Responsibilities

Emergency Management - Operations Center

Emergency Management - Labor Pool

Patient Charts

Disaster Welfare Inquiry

Emergency Management - Security

Emergency Water Supply

Emergency Management - Supplies, Utilities and Equipment

Essential Supplies, Utilities and Equipment Availability Data Form

Emergency Management - Evacuation

Emergency Management - Staff Training

Emergency Management - Training Record

Emergency Management Plan - Drills

Emergency Management - Evaluation

Emergency Management Plan Activation - Evaluation Form

Staff Support Programs

Bomb Threat

Bomb Threat Room Search

Bomb Threat Report Form

Earthquake Response Procedure

Hurricanes

Riot or Civil Disturbance Response Plan

Severe Winter Storms

Thunderstorms/Tornados

Disruption of Services Procedure

Disruption of Facility Services - Notification

Disruption of Services - Electric

Disruption of Services - Medical Gas

Disruption of Services - Natural Gas

Disruption of Services - Sewage

Disruption of Services - Water

Failure of Air Conditioning System

Failure of High Pressure Boilers

Failure of Elevators

Failure of Fire Alarm System

Failure of Telephone System

Failure of Piped Vacuum System and Compressed Air

Emergency Management - Admitting/Switchboard

Emergency Management - Dietary Department

Emergency Management - Engineering and Security Department

Emergency Management - Environmental Services

Emergency Management - Human Resources Department

Emergency Management - Medical Records Department

Emergency Management - Nursing Services

Emergency Management - Recreational Therapy, Therapeutic Therapy

Emergency Management - Social Service

Annual Evaluation of the Effectiveness of the Emergency Management Program

SECTION V - LIFE SAFETY MANAGEMENT

Life Safety Management Plan

Fire Safety - Chain of Command Key Personnel

Fire Safety - Duties of Department Directors and Supervisors

Fire Safety - Duties of Personnel

Fire Safety - Hazards

Fire Safety - Evacuation of Patients

Fire Safety - Smoking Policy

Materials or Equipment Purchases

Life Safety Code Compliance

Life Safety - Construction Suitability

Life Safety - New Construction

Statement of Conditions

Life Safety - Interim Construction

Fire Drill Policy

Fire Drill Report Form

Life Safety Summaries

Fire Alarm System Testing and Inspection

Fire Protection Systems - Inspecting, Testing and Maintaining Guidelines

Fire Alarm System Check Form

Fire Alarm Monitor Test Form

Fire Alarm Pull Stations - Securing

Fire Alarm Pull Station Test

Pull Station Test Form

Smoke Detector Inspection Procedures

Smoke Detector Test Form

Location of Fire Safety Smoke Detectors

Fire Dampers Inspection

Fire Door Inspection

Fire Door Inspection Form

Sprinkler Drop Test

Sprinkler Drop Test Form

Quarterly Fire Extinguishing System Check Form

Fire Control Valves

Sprinkler Heads

Fire Sprinkler System Repair

Fire Extinguishers - Securing

Fire Extinguisher Check

Fire Extinguisher Log

Types of Fire Extinguishers

Fire Safety - General Instructions

Fire Safety - Business Office

Fire Safety - Dietary Department

Fire Safety - Engineering Department

Fire Safety - Environmental Services

Fire Safety - Materials Management

Fire Safety - Medical Records Department

Fire Safety - Nursing Services

Fire Safety - Pharmaceutical Department

Fire Safety - Switchboard

Fire Safety - Volunteers, Students, Non-Staff Personnel

Prevention of Fire in an Oxygen Enriched Atmosphere

Annual Evaluation of the Effectiveness of the Life Safety Program

SECTION VI - MEDICAL EQUIPMENT MANAGEMENT

Medical Equipment Management Plan

Medical Equipment Management Program

Definitions of Maintenance Strategies

Equipment Management Code System

Selection and Acquisition of Equipment

Inventory and Inspection of New Equipment

Equipment Management Inventory

Equipment Management Inventory List

Additions to Equipment Management Inventory List

Deletions from Equipment Management Inventory List

Equipment Acceptance Checklist

Equipment Testing Log

User/Maintainer Training Program

Equipment Management Orientation/Education

Employee Equipment Training and Competency Form

Equipment User Error or Failures Form

Equipment Failure/User Error Follow-Up Report Form

Quarterly Report to Safety Committee - Equipment Management Incidence - Biomedical Engineering

Manufacturer Recalls and Hazardous Device Notices

Medical Device Recall Policy

Disposing of Recalls

Safe Medical Devices

Electrical Safety

Electrical Equipment Condition

Electrical Safety - Distribution Systems

Electrical Safety - Preventing Overload

Equipment Safety - Biomedical Engineering

Equipment Safety - Reporting Malfunctions

Personal Electric Equipment

Permit for Using Electrical Appliances

Extension Cords

Request For Electrical Extension Cord Form

Contract Service

Supervising and Monitoring Contract Services Checklist

Contracted Personnel Compliance Checklist

Outside Contractors Working in the Facility

Equipment Loan/Rental Policy

Preventative Maintenance

Biomedical Equipment Maintenance Action Report Form

Sterilizer Performance Testing

Preventative Maintenance:

Air Compressor

Anesthesia Unit

Apnea Monitor

Bedside Monitoring Device(s)

Bulk Steam Sterilizer

Crash Cart

Defibrillator

Dry Heat Sterilizer

Electric Beds

Preventive Maintenance Procedure for Electric Beds Form

Electroencephalograph (EEG)

Electronic Thermometer

Ethylene Oxide Sterilizer

Ice Dispenser

Noninvasive Blood Pressure Monitor

Pulse Oximeter

Scale

Table Top Steam Sterilizer

Television

Wall Suction

Annual Evaluation of the Effectiveness of the Equipment Management Program

SECTION VII - UTILITY SYSTEMS MANAGEMENT

Utility Systems Management Plan

Plant Operations and Maintenance

Engineering Rounds Log

Building Maintenance Program

Utility Systems Management - Inventory

Inventory of Utilities Equipment

Equipment Management Inventory List - Utility Systems

Additions to Utility Systems Management Inventory List

Deletions from Utility Systems Management Inventory List

Utility Systems Management - Emergency Power

Exhibit A - Power Systems Service Agreement

Utility Systems Management - Emergency Power Generator Maintenance

KVA Rating Specifications

Conducting Weekly Tests of Emergency Diesel Generators

Generator Test Log

Battery Power Backup

Lockout/Tagout Procedures

Sample Lockout/Tagout Labels

Lockout/Tagout Training

Guidelines and Procedure for Failure of Essential Equipment

Utility Systems Failure Chart

Emergency Numbers

Emergency Lighting and Power - Annual Inspections

Management of Utility System Failure - Electrical Power

Utilities Equipment Failures Log

Outside Vendor Assistance

Failure of Communication System

Elevator Failure - Passenger Evacuation

Ethylene Oxide Leakage

Failure of Fire Alarm System

Emergency Generator Failure

Failure of HVAC System

Failure of Medical Air System/Vacuum

Failure of Medical Gas Oxygen System

Failure of Natural Gas Supply

Failure of Nurse Call System

Failure of Plumbing System and Flooding Procedure

Failure of Pneumatic Tube System

Failure of Steam Delivery Boilers

Failure of Vertical Lifts (Including Dumbwaiters, Cart Lifts)

Failure of Water Distribution System

Safety Testing and Preventative Maintenance of Utility Systems

Preventative Maintenance

Preventative Maintenance - Boiler and Steam System

Preventative Maintenance - Electrical Distribution System and Generator

Evaluation Form - Emergency Lighting and Power Systems

Electrical Distribution Annual Check

Condition of Electrical Receptacles

Filter System Log Policy

Filter Log Form

Preventative Maintenance - HVAC System

Indoor Air Quality Program

Air-Handling and Ventilation Systems

Preventative Maintenance - Medical Air and Vacuum System

Preventative Maintenance - Medical Gas System

Piped Medical Gas System Testing

Torn Media Inspection

Torn Media Inspection Form

Preventative Maintenance - Vertical and Horizontal Transport System

Preventative Maintenance - Water Distribution and Plumbing System

Maintenance and Monitoring of Water Systems

Cooling-Tower Inspection Form

Water Conditioning

Water Treatment Test Form

Utility Systems Management - User/Maintainer Training

Engineering Department Training Log

Utilities User/Maintainer Training Log

Utility Systems Management - Continuing Education

User Training for Utilities Equipment Log

Sample Training Outline - General Facility Knowledge

Sample Training Outlines:

Communication Systems

Facility Electrical Distribution System

Safe Use of Electrical Equipment

Emergency Generator

HVAC System User

Medical Gas

Use of Medical Gas Delivery System

Handling, Storage and Transport of Compressed Gas Cylinders

Medical Gas Alarms Test

Breached Medical Gas Lines

Use of Pumps and Motors

Steam Boiler

Underground Storage Tanks

Use of Water Delivery System

Utility Systems Shutdown

Utility Systems Record Drawings

Electrical Distribution System Shutdown

Electrical System Shutdown Switches

HVAC System Shutdown

Emergency Shutoff of HVAC System

Valve Shutoff Locations - Oxygen Supply

Utility Systems Management - Emergency Shutoff Labels

Sample Shutoff Labels

Utility Systems Management - Problems, Failures, User Errors

System Failure Report Form

System Failure Report Log

Utility Systems Management - Identified Problems

Problems Resolution Log

Quarterly Report to Safety Committee - Utility System Incidence - Engineering Department

Annual Evaluation of the Effectiveness of the Utility Systems Management Program

SECTION VIII - PHYSICAL ENVIRONMENT

Physical Environment

Facility Building

Structural Restraints

Dining Area/Nutrition Services

Patient Rooms

Hygiene/Grooming

Therapeutic Environment

Animal Visitation