Safety Committee

Emergency Plan

Same month every year (annually)

Complete the Data Sheet.

Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)

Your License must be renewed every 2 years

Renew License Form: 60 days before to expiration date.    CLIA application form

Training In Our Office

Every semester we offer 1 or 2 in-office training to your employees.

Annual Minutes of Safety Committee meetings

The following templates, must be used as Agenda for your meeting, the Administrator and DON must assure that the meeting was done with acceptable quorum, and active participation of each member of the committee.

Regular annual minute (May each year, plus Staff Emergency annual In-service):

Members: Administrator, DON, Alt. Administrator, Alt. DON

Annual Meeting: Safety Meeting Minutes      

Activation of Emergency Plan minute:  Activation EP minute

All tasks must be completed (CoPs):

Table Top Exercise (Annual):    Table Top Exercise

Disaster Drill (before Hurricane Season or other area hazard season each year)

Disaster/Fire Drill   A full-scale community-based exercise with the county DOH, must be coordinated and noted (if community base is not available in your area of services, must complete a facility base drill (twice a year).

Community Base exercise documentation: Community Base Disaster Drill report   Must be complete if community base  

                                                                                       exercise was completed, involved the community, other healthcare facility, etc.

Miami Dade Community Response web      Miami Dade Healthcare Preparedness Coalition

Business Continuation Plan (before Hurricane Season each year)

Business Continuation Plan

Business Communication Plan               

 Business Communication Plan               

Exercise Evaluation (Disaster/Fire Drill Evaluation) (Bi-Annual)

Exercise Evaluation                                    After Disaster Evaluation: Emergency Plan Evaluation

                                                                                     (Complete only after any community disaster threat) 

Office Safety Inspection Report (Annual)

Office Safety Inspection Report

Administrator/DON: Emergency Control Log (Monthly) (by category, can be Software generated)

Emergency Control Log

 Hazard Vulnerability Analyzes

Hazard Vulnerability Log

Emergency In-Service  Emergency In-Service      OSHA Hazard Communication      SDS Log (OSHA)

PANDEMIC MANAGEMENT REPORTS:

  Emerging Infectious Disease (EID) report (Add to Communication Plan)     Goverment COVID-19 resources

EID Report   (forward copy to Board of Director & Infection Prev. Committee)           

Pandemic Log Control:  Patients                 Staff

Caring for COVID-19 Patient documentation  Caring for Covid19 documentation  (Add to progress note)

Daily Screening Protocol:  Daily Screening     (must be completed daily to all Agency staff/visitors)

Pandemic screening tool:   Pandemic Screening    Caring for COVID-19 Patient guide (CHAP)  Caring for Covid19

(Only 1 time)

Pandemic Agency Actions                                          Pandemic Response Roles

Pandemic Actions                                                       Pandemic Roles

Pandemic Infection Prevention                               Pandemic Home Care Planning

Pandemic Infection Prev.                                           Pandemic Agency HC planning report  

Agency Pandemic Management Plan:                     CMS Guidelines Coronavirus

Pandemic Mgm Plan                                                   Coronavirus CMS guidelines          

Person Under Investigation (PUI) and Case Report Form:  Coronavirus PUI                             

COVID-19 Resources        National Emergency Waivers:  Waivers         CHAP Video waivers    FL Waivers

We encouraging organizations (CHAP and non-CHAP accredited) to participate in CHAP weekly COVID-19 conference calls. They have those calls on Tuesdays at 10:30 AM EST, Wednesday at 11:00 AM EST, and Thursday at 3:00 PM EST.  The call in number is 646-307-1479, participant code 246854#.  In addition, CHAP have a COVID-19 hotline for immediate questions 202-862-3416 (Monday-Friday 8:30 AM-5:30 PM EST).

CHAP Video: COVID19 tips              Patient/family Instructions: COVID19 English        COVID19 Spanish

JCHO Surveys Video: COVID19       CDC Infection prevention recommendation  CDC video

ACHC Instructions  COVID19           General Instructions Posters:  Poster English        Poster Spanish

Safety Tracking LOG (All year long)

Safety Tracking Plan

Staff Safety Incident Report (to report if needed)

Staff Safety Incident Report

Disclaimer: Every template is only your guide/AGENDA to type the Minutes of your meeting, your Agency Officials must assure that the meeting occur, the quorum is acceptable, and every member had active participation in the discussion