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

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 EP minute:  Activation EP minute (if applicable)

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 completed if community base  

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

Business Continuation Plan (before Hurricane Season each year): Business Continuation Plan

Business Communication Plan:  Business Communication Plan               

Exercise Evaluation (Disaster/Fire Drill Evaluation)   (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:     OSHA Hazard Communication      SDS Log (OSHA)     OSHA’s Form 300  Osha's 300

Safety Tracking LOG (All year long)

Safety Tracking Plan                                           Specialty Shelter Refuse Registration:     Shelter Refuse Registration

Staff Safety Incident Report (to report if needed)

Staff Safety Incident Report

COMMUNITY RESOURCES:

Miami Dade Community Response web          Miami Dade Healthcare Preparedness Coalition

Miami Dade Emergency Plan                              Hillsborugh County Emergency Plan

Collier County Emergency Plan                        Broward Coutny Emergency Plan

Palm Beach County Emergency Plan               Orange County Emergency Plan

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