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Surge Tool Kit and Facility Checklist

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Facility Checklist

Facilities/Advanced Patient Care

Layout and potential use of former advanced care areas for general surge. Aspects being evaluated for general surge capacity, not for original purposes.

Date: ____________  Location: _______________________  Team member: __________________________

Operating Rooms

 

Observations:  

 

General Condition:  

 

Description of Structural Components

Floors:  
Ceilings:  
Windows:  
Doors:  
Missing, Damaged Structural Components (Note Location):  

 

Pests/Mold

Description and location:  

 

Communications

Nurse call system?  
Other?  
Telemetry system?  

 

Lighting

Regular:  
Emergency:  

 

HVAC and Air Flow (ducts, vents, and radiators)

General condition:  

 

Air Flow:

Y N Sinks?
Y N Floor drains?

 

Fire Suppression:

Y N Sprinkler heads?
Y N Extinguishers?

 

Waste Management and Hazardous Materials:

Y N Containment and storage capability?
Y N On-site treatment/management set-ups?

 

Hazardous Materials Management (storage, use):

Y N Segregated hazardous wastes storage?
Y N Shielded radioactives storage?
Y N Eye washes, drench showers?
Y N Flammables cabinets?
Y N Compressed gases chains?

 

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The information on this page is archived and provided for reference purposes only.

 

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