Emergency Plan
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Renew License Form: 60 days before to expiration date. CLIA application form
Every semester we offer 1 or 2 in-office training to your employees.
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 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)
Hazard Vulnerability Analyzes
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)
Staff Safety Incident Report (to report if needed)
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
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