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CEHCKLIST

The document is an Emergency Preparedness Audit Form for nursing homes, detailing inspection sections on building safety, emergency preparedness, systems maintenance, and documentation. Each section includes specific requirements and compliance checks based on relevant by-laws and standards. The form concludes with a summary of findings, including total compliant items and notes on non-compliance.

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Nuratiqah Eyen Abdullah
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3 views3 pages

CEHCKLIST

The document is an Emergency Preparedness Audit Form for nursing homes, detailing inspection sections on building safety, emergency preparedness, systems maintenance, and documentation. Each section includes specific requirements and compliance checks based on relevant by-laws and standards. The form concludes with a summary of findings, including total compliant items and notes on non-compliance.

Uploaded by

Nuratiqah Eyen Abdullah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Emergency Preparedness Audit Form for Nursing Homes

Facility Details

Name of Nursing Home: _______________________________________

Address: ______________________________________________________

Date of Inspection: ____________________

SECTION A: BUILDING SAFETY (Based on UBBL 2022)

COMPLIANT?
ITEM REQUIREMENT REMARKS
(✓/✗)
Fire exits available and At least 2 per floor (By-Law 127)
unobstructed
Exit routes clearly marked Illuminated, visible (By-Law 132)
with signage
Travel distance to exit < 30m Per Sixth Schedule
Emergency lighting Battery-backed (By-Law 213)
operational
Fire extinguishers present & Wall-mounted, inspected yearly (By-
maintained Law 191)
Fire alarm system functional Audible in all areas (By-Law 189)
Staircases fitted with Non-slip, compliant (By-Law 65)
handrails
Ramps provided for Gentle slope, handrails (By-Law 85)
wheelchair access
Exit doors swing outward Easily openable in emergencies
and unlocked (By-Law 133)
Assembly point identified Located at a safe distance
SECTION B: EMERGENCY PREPAREDNESS (Based on MS 2735:2021)

COMPLIANT?
ITEM REQUIREMENT REMARKS
(✓/✗)
Emergency Response Plan Updated, site-specific (Section 6.2)
(ERP) available
Risk Assessment conducted Identifies credible emergency scenarios
(Section 6.1)
Emergency Planning With defined roles (Section 7.2)
Committee (EPC) formed
Emergency Response Team Names, roles, responsibilities listed
(ERT) appointed
First aid kits available and Easily accessible, up to date
complete
Staff trained on fire Evidence of training/refresher (Section
evacuation 9)
Evacuation drills conducted At least once a year (Annex C)
Personal Emergency For bedridden or disabled residents
Evacuation Plan (PEEP) (Section 3.27)
Emergency contacts Local hospital, Fire & Rescue, ERT
displayed (Section 6.2)
Communication system Alarms, PA, backup systems
tested
SECTION C: SYSTEMS AND EQUIPMENT MAINTENANCE
COMPLIANT?
ITEM REQUIREMENT REMARKS
(✓/✗)
Fire extinguishers Within last 12 months
inspected
Emergency lights Tested monthly
functional
Smoke detectors working Covered all sleeping areas
Fire doors operational Close automatically
Exit signs illuminated Battery-backed

SECTION D: DOCUMENTATION
DOCUMENT AVAILABLE & UPDATED? REMARKS
ERP document
Risk assessment report
Drill attendance & reports
ERT member list with roles
Maintenance logs

Summary of Findings
Total Items Compliant: ______ / ______

Non-compliant Items Noted:

- __________________________________________________________

- __________________________________________________________

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