Name of Hospital: _________________________________________ Date: ____________________

Name of Evaluator: ________________________________________

Indicators Means of verification Low Average High Evaluator's Comments

MODULE 3: Nonstructural safety

3.3 Critical systems

Alternate source (KVA) capacity

should be 100% the load of all
Alternate source supplies 100%
Alternate supply less than critical areas and starting time
38. Capacity of alternate sources of electricity (e.g. generators) the load of all critical areas or does
Evidence of emergency testing, routine 50% of all critical areas starts automatically in less than 10
not start in 10 seconds
maintenance, availabity of electrical seconds.
drawings, load calculation in KVA to
determine the power requirement of all
critical areas, nameplate of genset. (eg.
Single line diagram, equipment schedule)
This item addresses both the capacity of alternate sources and the length of delay in 100% for Critical Areas & Life Saving
starting the Equipment. Critical Areas: OR, all ICU's,
alternate source of power for critical areas of the hospital in emergency and disaster ER, Delivery Room, Medical Gas Equipmt,
situations. Verify that the alternate source(s) of power begin(s) to operate within ten All Laboratory rooms, Dialysis, Diagnostic
seconds of the hospital losing power and continue(s) to operate to cover power demands Areas
for critical services throughout the hospital – particularly in the emergency department, Life safety : Fire Pumps, Emergency Lights,
intensive care unit, sterilization units, operating theatres and maternity unit (i.e. areas of PABX (Private Automatic Branch Exchange)
the hospital that are most critical to meeting service demands in times of emergency. Item system, Fire Detection & Alarm System
39 covers regular tests of alternate sources of electricity. Confirm that the hospital’s power (FDAS)
plant operators have training in emergency preparedness and response. All work areas
should be checked to see that there are flashlights and basic communications equipment
available.

Tested at full load semi-annually or

No full load test conducted
Tested at full load annualy or weekly testing at no load. Record
39. Regular tests of alternate sources of electricity in critical areas or conduct no load testing
monthly testing at no load of the test is present-using service
quarterly or less
Evidence of actual real life test, (calendar of report and/or contact document.
real life test conducted), load calculation,
Determine how frequently generator performance tests with satisfactory results review of as-built electrical plans)
are carried out by examining maintenance and test records. It allows for potential failures
in the system to be anticipated and can indicate measures that need to be taken should a
failure occur.

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Generator in good conditions and
complies by 100% with all
protection and security measures:
installed in appropriate location
(indoor/outdoor), if outdoor,
Generators are in poor
Generators are in fair condition; provided with cover, no potential
condition; protective
protective measures provide less for flood damage, vandalism, or
40. Condition and safety of alternate source(s) of electricity measures provide less
than 100% but not below 50% theft, sufficient drainage to avoid
than 50% protection and
protection and security. flooding, bracing, anchorage, and
security.
seismic supports are in place, safe
access to equipment, fuel storage
and fuel tanks, batterries in good
condition, earthing in place, safety
signages.

Determine whether or not the generator(s) are fundtional and based on this, the most
appropriate location for them. For outdoor generators, evaluators should inspect the
casing and any form of protective covering. Depending on the location, the potential for
flood damage, vandalism or theft of generators should be evaluated. The vulnerability of
generators to strong winds, seismic forces or proximity to adjacent structures that might fall Calendar/schedule of maitenance, any
and cause damage should also be evaluated. Drainage at the generator’s location should existing policy on maitenance and safety,
be evaluated (i.e. how run-off is managed if the equipment is outside and, if placed electrical drawings.
indoors, whether there are floor drains or openings. Visual inspection can be
supplemented by information from maintenance and inspection records.
Ascertain whether the generator is well-anchored and braced, without the possibility of
falling or shifting. This involves inspection of supports for the generator in the ground or
flooring and the condition and type of connections (i.e. checking for corrosion or other
deterioration). If springs are used to avoid vibration and noise, they must be well-anchored
since these devices amplify seismic waves. The connections for fuel lines and electricity
cables must be flexible to avoid breakage should the generator shift or fall. The lower that
these heavy pieces of equipment are placed in the structure, the less the chance that they
will fall over, but they may still slide.
There should be easy and safe access to the equipment. The possibility that doors or
other exits could be blocked by cables or fuel lines if the equipment shifts or falls should
be considered.
Check the availability and storage of fuel, confirming that supplementary tanks are
always full and are located so that fuel can reach the generator by gravity rather than
relying on pumping at the time of an emergency. Inspect the physical condition of the fuel
tanks and electrical and hose connections. Batteries can be highly dangerous, particularly
when charging, and are prone to serious risk in an earthquake, wind, flood or fire event.
The condition of the batteries and replacement batteries for the starter should also be
inspected to ensure that they cannot be damaged. Check for earthing.

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Compliance to the following criteria:
100% PVC (Polyvinyl chloride)
conduit is used for embedded
installations only, IMC(Intermediate
Electrical equipment,
Metallic Conduit) are used for
power lines, cables and
exposed and above ceiling
ducts are in poor condition, Electrical equipment in condition
installations, anchorage and
41. Condition and safety of electrical equipment, cables and cable ducts there are no protective and compliance to below criteria is
supports, protection from flooding
measures and compliance below 100% but not below 50%
and risk of fire, flexible joints are
to below criteria is below
used for earthquake mitigation, for
50%.
outdoor power lines, if above
ground, electrical poles are in good
condition, mus be free from
interference (eg. tree braches).

Check the condition of the electrical networks throughout the hospital. These
should be protected from flooding and fire, and in earthquake-prone zones and areas of
high winds they should be anchored and channelled through cable racks or conduits that Electrical as-built plans: type of materials
protect them from twisting, breaking or from general deterioration. When cables travel used, anchorage power lines secured
along roofs that empty through drainpipes or gargoyles, the cables should be positioned
above the overflow level. When the building has a basement or other areas that are likely
to flood, evaluators should inspect the location of sockets, large switchgear or isolators
and whether they need to be raised. In earthquake-prone areas, when electricity lines
pass from building to building or over expansion joints in the same building, these joints
should have sufficient flexibility to accommodate the relative movements during
earthquakes.
An important element is the separation of electrical networks from other systems that
they may affect – such as water supply or sewage systems. If they are in close proximity to
protective systems for electrical atmospheric discharge, consideration should be given to
metal shielding and additional electrical earthing and bonding.
Inspect the position of outside power lines in relation to features on the hospital grounds.
All power lines on hospital grounds should be placed underground to protect them from
damage and flying debris during high winds. If electricity poles are located on hospital
grounds, evaluators should ensure that transformers are well anchored. The possibility
that poles could fall because of soil liquefaction, wind or other hazards should be
considered. Tree branches can break or interfere with above-ground power lines; likewise,
tree roots can interfere with buried power lines.

42. Redundant system for the local electric power supply There are more than two (2)
No redundant power There are two (2) entrances for the
LEFT BLANK IF NOT APPLICABLE entrances for the local power
supply local power supply.
supply
The failure of local power supplies can cause a “domino” effect in the hospital so that
successive outages can occur. Evaluators should confirm that there is redundancy in the
power supply, without counting on the hospital’s own emergency power-generating
system. If possible, there should be more than one power supply entrance to the hospital
from the local power supply, and additional entrances should be from other circuits that
are independent of the internal emergency system.

Accessible, sufficient drainage to

avoid flooding, properly supported
and anchored, with
labels/identification, overload and
Control panels or other Control panels or other elements mechanical damage protection,
elements are in poor (eg. are in fair (eg. Anchorage is protected from risk of fire,
43. Condition and safety of control panels, overload breaker switches and cables Anchorage and labels are present but not properly fixed, connected to the emergency back-
absent) condition, there labels present but not readable, up system.
are no protective measures etc.) condition.

Avaiability of maintenance record, presence

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MODULE 3: Nonstructural safety

Evaluators should check the accessibility, condition and operation of the general
distribution board, isolators, switchgear, and control panels throughout the facility. Avaiability of maintenance record, presence
Locations should be checked to ensure that access cannot be blocked, doors and of labels for distribution boards, panel
windows are intact, measures are in place for the prevention of fire and that there is boards, and as-built drawings.
sufficient drainage to avoid flooding. The function of the distribution board, the capacity of
the breaker, its connections to the system, and the supports or anchors used for all of the
panels and corresponding equipment should be checked. This could be done by a
combination of examining maintenance records and visual inspection. Distribution boards
or panels should be labelled to indicate which control and protection devices serve each
circuit in different areas. Evaluators should also check that the control panels are
protected from the risk of fire, overload and mechanical damage (e.g. earth leakage circuit
breakers, power overload breakers, load test and auto changeover switches to
generators).
Connections to the emergency back-up system, emergency lighting and interior alarm
systems should be inspected. If these connections are located close to the emergency
generator, all cables should be appropriately channelled, in good condition and
identifiable.

Adequate (100% based on

Does not comply with standards set) illumination in critical
Lighting is satisfactory but does not
illumination (below 70%) areas in compliance with
44. Lighting system for critical areas of the hospital meet minimum illumination (70% to
standards (lighting level for recommended illumination levels.
99%) standards.
the hospital). Lighting level verified using LUX
meter test instrument.
Availabiity of electrical drawings, plan and
testrecords, measurement of lighting level
using LUX Meter, adequacy of illumination
level.
Review lighting in critical areas of the hospital, including the emergency department,
intensive care unit, operating theatre, laboratories etc.Test levels of lighting in rooms,
the function of lighting fixtures, and the safety of their bracing or supports. Some lights are
suspended from ceilings, others are attached to the structure. In surgery or obstetrics,
lights should be bolted to beams. Ensure that lighting fixtures are not supported by false
ceilings. Confirm that lighting is connected to the emergency power system or UPS.
(Uninterruptible Power Supply). Check maintenance and inspection records.

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Installation, location and
working condition of Installation, location, and working
45. Condition and safety of internal and external lighting systems Installation, location, and working
lighting in critical and conditions of lighting in critical and
conditions of lighting in critical and
common areas are not common areas with adequate
common areas withpartial levels of
complied including levels of protective measures
protective measures (bracing and
Criteria for Evaluation: protective measures (bracing and supports). With
supports). With partial stock of
(bracing and supports). sufficient stock of lighting supplies
lighting supplies (e.g. batteries,
With no stock of lighting (e.g. batteries, flashlights, light
flashlights, ligt bulbs).
supplies (e.g. batteries, bulbs).
flashlights, light bulbs).
Availability of drawing plans and records.

Ensure that both internal and external lighting are operational and correctly sectioned
Interview maintenance staff to determine whether there is sufficient stock of lighting
supplies (e.g. flashlights, head-torches, batteries and light bulbs in case of light failure in a
disaster). Ensure that emergency lighting systems are adequate for the level and type of
use of an area, especially on stairs and walkways, in corridors and in the critical medical
and nonmedical areas of the hospital. Lighting should be clear of plants or other
vegetation which could pose a physical risk or affect performance. Check maintenance
and inspection records.

46. External electrical systems installed for hospital usage Electrical sub-stations (for major Electrical sub-stations (for major
hospital with demand >750kVA) or hospital with demand >750kVA) or
No electrical sub-stations transformers installed in transformers installed in
for major hospital with inappropriate location (prone to appropriate location (not prone to
demand >750kVA or flooding, close to vegetation), flooding, not close to vegetation),
IF THERE ARE NO EXTERNAL ELECTRICAL SUBSTATION, LEAVE BOXES BLANK
transformers for minor partially protected and vulnerable well protected (enclosed, labelled,
hospitals. to damages, and does not provide anchored and supported), and
enough power in an provide enough power in an
emergency/disaster. emergency or disaster

Availabiliy of electrical drawings , presence,

Evaluators should verify the existence and capacity of external substations or transformers capacity and location of substance and
that provide power to the hospital either on hospital grounds or in close vicinity. These transformer and their protective/safety
systems should be completely enclosed and there should be labels and signs clearly devices.
indicating that they are power sources. They should be isolated from fuel tanks. The
substations should not be subject to damage from flooding or heavy rain. Anchors or
supports should be sufficient to prevent them from tipping over or sliding. Evaluators
should take into account the possibility of oil leaks in the case of a transformer and breaks
in electrical cables. Transformers or substations should not be placed close to vegetation
– especially trees because branches can break or interfere with above-ground power
lines. Likewise, tree roots can interfere with buried lines. Power sources should be
protected from lightning and other atmospheric electrical discharge.

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MODULE 3: Nonstructural safety

Operation manual and preventive
Operation manual and preventive
maintenance records and
maitenance records and
emergency procedures for
NO maintenance records emergency procedures for
maintaining normal and alternate
and no personnel with maintaining normal and alternative
47. Emergency maintenance and restoration of electric power supply and alternate sources systems in emergency /disaster
required or relevant systems in emergency /disaster
situations and personnel have
Availability of Contingency Plan and training. situations are not updated
been trained to maintain systems in
emergency procedure, permit to operate the andpersonnel have no required or
both routine and
generator, maintenance record, checklist for relevant training.
emergency/disaster situations.
conducting inspection, operations and
maitenance manual, training certificates on
The maintenance division should provide the operations manual for electrical power how to operate genset.
systems, as
well as preventive maintenance records. Verify that there are emergency procedures for
maintaining systems in emergency/disaster situations. Check that personnel have been
trained to an appropriate standard to maintain the correct level of safety of the electrical
power supply and alternate source (e.g. generators) of the hospital in both routine and
emergency/disaster situations.
3.3.2 Telecommunications systems

Deteriorated bracings, not well With adequate bracing and

No bracing for antennas
48. Condition and safety of antennas protected from theft, vandalism and support, safe and well protected
not well protected.
hazards. from theft, vandalism and hazard.

Availability of maintenance record

Verify the condition of antennas, satellite dishes, external control boxes and their roof
fixings, bracings and supports. There should be at least three tiedowns at 120° intervals;
four tie-downs should be spaced at 90° intervals. Grounding devices for lightning rods
should be correctly installed and should not be used to anchor other systems. Access
walkways to antennas and related equipment should be safe and well-protected from
hazardous phenomena. Visual inspection can be supplemented by information from
maintenance and inspection records.
IF THERE ARE NO ANTENNAS, LEAVE BOXES BLANK.
- System equipment and
components well-protected AND
- Cables secured from strong
winds or flooding AND
Poor protection of low Partial protection of low voltage
49. Condition and safety of low- and extra-low-voltage systems (Internet and telephone) - Cables segregated from other
voltage system. systems
electrical sources and well-
protected (e.g tubes, boxes, or
placement 0.5 meters above the
floor)

Low-voltage and extra-low-voltage systems may have antennas, transmission equipment,

line and voltage controllers, receivers, wiring and a grounding mechanism so evaluators
should verify the status of each part. Verify that cables are properly connected in strategic Availability of plans, drawings and
areas to avoid system overload. Cables for computer and telephone networks should be maintenance records.
protected from events such as high winds and flooding, so that the systems can function in
adverse conditions. The main components of lowvoltage and extra-low-voltage systems,
such as servers and network hubs, should be in protected areas that are free of items that
could potentially block access and ingress.
To connect the telephone exchange to each of the extensions or telephones in a
building, there is a system of wires that must be segregated from other electrical sources
to avoid overloading the system and to protect against their being damaged by different
voltages. Likewise, internal communications wires must be segregated. The wires should
be protected according to the appropriate standards and legislation – for instance,
protection in electrical tubes or boxes, and placement above the floor (e.g. at 0.5 metres).
Check maintenance and inspection records.

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MODULE 3: Nonstructural safety Radios, pagers and modems all

Alternative systems not tested functioning, connected to the
50. Alternate communication systems NO alternative systems
annually emergency power system and
tested annually.
Availability of functional alternate
Verify the condition of the hospital’s alternate independent communications systems communication system, records of alternate
(including radio-communications, satellite telephone, Internet, mobile telephones, pagers) communication testing done.
to maintain internal as well as external contact in the event of an emergency or disaster.
Components of internal networks should be reviewed to ensure that vulnerabilities at
different points of the system have been eliminated.

Functional and in good condition

AND well protected and anchored
AND (Installed in a conduits to
Telecommunications
Telecommunications system is not protect from deterioration).
51. Condition and safety of telecommunications equipment and cables systems not well protected
properly anchored/protected.
and anchored.

Availability of maintenance and inspection

records.

The condition and functionality of the telecommunications equipment and cables in the
hospital should be checked. Verify that all telecommunications equipment is well-protected
and anchored for increased security. Outside cables on the hospital grounds should be in
underground conduits to protect them from damage during high winds and other hazards.
Telephone exchange consoles, computers and servers should have anchors to prevent
tipping or sliding. In areas which require anchoring and/or bracing, the quality of anchors
and braces should be assessed. There should be adequate conduit tubing for cables to
prevent them from deteriorating. Mobile telephone towers in the vicinity of the hospital
should have back-up generators. Visual inspection can be supplemented by information
from maintenance and inspection records.

External telecommunications
External communications cause no
Site in poor condition or systems occasionally cause
52. Effect of external telecommunications systems on hospital communications interference with hospital
vulnerable to hazards. interference with hospital
communications
communications

Availability of examining maintenance

External telecommunications systems, radio transmitters and similar systems that are record, site plans and drawings.
placed near the hospital may cause interference to hospital communications networks.
Evaluators should verify that exterior telecommunications systems do not interfere with the
communications of the hospital. This can be done by examining maintenance records, site
plans and drawings, and by talking with staff.

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MODULE 3: Nonstructural safety

Enough space to accommodate all Enough space to accommodate all
equipment; Entry ducts have fire equipment and maintenance; Entry
barriers with swing-out doors; ducts have fire barriers with swing-
Doors and windows are tightly out doors; Doors and windows are
Site in poor condition or
53. Safety of sites for telecommunication systems closed; Doors are not fire resistive; tightly closed; with fire resistive
vulnerable to hazards.
PABX room should be at least doors;; PABX room should be at
4meters from sources of least 4meters from sources of
electromagnetic interference; not electromagnetic interference; not
vulnerable to water damage. vulnerable to water damage.

Check the condition and safety of the sites for the telephone exchange and computer
network server. Entry ducts should have fire barriers, doors must open completely and
away from the room, suspended ceilings that can fall easily should be avoided, and no
pipelines should be co-located here. Doors and windows should close tightly to keep out
wind and water, and doors should have moderate fireproofing. Lighting should be
adequate for personnel to work, but the equipment should be protected from direct
sunlight. To avoid water damage, water filtration apparatus, toilets and bathrooms should
not be on floors above the equipment. Availability of drawing, maintenance and
Telecommunications centres must be placed away from facades. Cables and wires inspection record/report.
should be encased in conduit tubing to prevent deterioration and all equipment should be
anchored according to its weight and dimensions.Verify that installations are not subject to
explosion in case of sparks.
Check distance from electromagnetic interference such as imaging equipment,
transformers, motors and radio transmission systems.
Access to the telecommunications centres must be restricted and controlled. Visual
inspection can be supplemented by information from maintenance and inspection records.
Battery storage areas should be ventilated separately. Batteries should be sealed. If
other types of batteries are used (non-sealed batteries) for reasons of economy, these
should not be placed in the same location as the telephone switchboard, and their location
must have the following specifications:
• It should be away from equipment and the operator, and antacid treatment must be
applied
to the floors and walls up to 1500 mm above the finished floor level.
• It should not have an outlet or interruptor placed inside, outfitted with shatterproof lamps,
and
doors should have moderate fireproofing. The battery should be protected from direct
sunlight.
• There should be a sink with a salt-water battery.

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Internal communications system is
operational and audible,;
Internal communications Internal communications systems
availability of inspections, testing
54. Condition and safety of internal communications systems systems do not exist and or are in fair condition, but there are
and maintenance of Internal
not operational. are no back-up systems..
communications ;back-up systems
are in good working order.

Presence of internal and alternate

communication system, report or record of
Verify the condition of loudspeakers, public address systems, speaker systems, intercoms testing done.
and similar systems that serve to facilitate communication with personnel, patients and
visitors to the hospital.Confirm the existence of audible systems such as bells and horns
that are used as alarms or alerts for evacuation. The existence of redundant and alternate
systems for internal communication guarantees that personnel, patients and visitors are
contacted quickly and clearly in emergencies and disasters. The evaluators should
request that the internal communications systems are tested and should confirm that
messages were well received.

Documented procedures exist,

NO maintenance records Documented procedures exist, maintenance/inspection records
55. Emergency maintenance and restoration of standard and alternate communications of emergency alternate maintenance/inspection records are up to date, personnel have
systems communications; no are up to date, but personnel has been trained, and resources are in
personnel trained. no relevant training. place for implementing emergency
maintenance and restoration.
Availability of test records, maintenance
record and documented emergency
The maintenance division should provide the operations manual and preventive
procedures, evidence of trained personnel.
maintenance records for electrical power systems. Verify that there are emergency
procedures for maintaining standard and alternate communications systems in
emergency/disaster situations. Check that personnel have been trained to an appropriate
standard to maintain the correct level of safety of the communications system and the
alternate source of communications in the hospital in both routine and emergency/disaster
situations.

3.3.3 Water supply system

Demonstrated capacity and
Demonstrated capacity and
56. Water reserves for hospital services and functions No reserve water functionality to hold in 3 days
functionality for less than 3 days.
storage.

Evaluators should verify that water tanks have a permanent reserve that is sufficient to
provide water for at least 72 hours in accordance with Uniform Plumbing Code of the
Philippines, in addition to a water reserve for fires (it is advised to provide at least 300 litres Availability of drawing, plans and
daily per bed). Evaluators should also verify that water storage is sufficient to satisfy specification, maintenance and inspection
essential services and has the capacity to store 1,172 liters per bed (daily demand for records on testing of tank functionality.
water supply intended for domestic and other hospital uses. This could be ascertained
from service and maintenance records. Typically, water storage for hospitals is in cisterns
or reserve tanks on the ground floor and elevated tanks. It is important to check locations
in the hospital that are not served by the main water system. If wells, boreholes or aquifers
exist on hospital grounds, the percentage of water supply they provide and whether they
are used regularly or as reserves should be ascertained.

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MODULE 3: Nonstructural safety Water tanks/cistern is

Water tanks/cistern is located in
located in areas Water tanks/cistern is located in
areas not susceptible to flooding,
57. Location of water storage tanks susceptible to flooding, areas not susceptible to flooding
safe to contamination, and safe
prone to contamination and and safe to contamination.
from landslide.
landslide.
Check that:
- Cistern is not susceptible to flooding Availability of maintenance and inspection
- Safe to contamination records, presence of preventive measures
- Location is safe from landslide against contamination, site development
- Connection to water tanks has adequate flexibility to withstand shaking during an plan to verify distance from source of
earthquake contamination, water supply plan.
- Tanks has appropriate covers, safe and properly secured
- No damage (e.g. cracks, corrosion, mold, etc.)
- Tanksare properly secured, braced or anchored.
- Maintenance and inspection records is available
IF THE HOSPITAL DOES NOT HAVE A WATER STORAGE TANK, LEAVE BOXES
BLANK. (THIS NOTE SHOULD BE DELETED)
Not less than three elements of the
All elements of the water
water distribution system including
distribution system including valves
valves functioning properly, pipes
functioning properly, pipes and
and fittings show no signs of
fittings show no signs of leakage
leakage and deterioration, pipes
No or no conformity of and deterioration, pipes properly
properly provided with bracing,
58. Safety of the water distribution system Microbiological Test to provided with bracing, anchored,
anchored, and provided with
PNSDW. and provided with flexible
flexible connections (connections
connections (connections between
between pumps and pipes) are
Evidence or report of water analysis pumps and pipes) are complied.
complied. Microbiological Test for
conducted, availability of water system plan, Microbiological Test for water
water quality conforms with
availability of water testing and maintenance quality conforms with PNSDW.
PNSDW.
record.
Check that:
- Check condition of water distribution line, storagetanks, valves, pipes & connections
- Valve function properly
- Check condition of pipe distribution line, no sign of leakage, deterioration
- Pipes is properly provided with bracing, anchored & has provided with flexible
connections (connections between pumps and pipes)
- Water supply meets water quality standards with water analysis conducted regularly
- Availability of water safety plan
- Availability of inspection, testing & maintenance records
No alternate supply or with
Availability of one alternate supply Availability of two or more alternate
alternate supply can only
59. Alternate water supply to the regular water supply that can provide 50 to 80% of the supply that can provide more than
provide less than 50% of
MOA/MOU with other water supply daily demand. 80% of the daily demand .
the daily demand.
providers, Microbiological Test for Water
Check that: Quality and Residual Chlorine, availability of
- Verify if there is available alternative water supply Disaster Risk Reduction and Management
- Water supply from local water supply distributor in Health Plan.
- Supply from local Fire Department
- Supply water tankers trucks has sufficient access to supply the facility.

least 1 back-up pump systems that At least 1 back-up pump systems

can supply 100% of daily demand that can supply 100% of daily
60. Supplementary pumping system There is no back-up pump.
for water without power supply demand for water with 100% power
access from genset. supply from genset.
Records of pump test, availability of
Check that: inspection, testing and maintenance record.
- Pumping system has redundant pumps operating as duty or standby (at least 2-pumps)
- Pumps is operating in a alternate mode
- Pumps is supplied with 100% power supply back-up from the genset
- Inspection, testing and maintenance records is available

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MODULE 3: Nonstructural safety Operation manual and preventive

Operation manual and preventive maintenance records and
maintenance records and emergency procedures for
No maintenance records emergency procedures for maintaining normal and alternate
Availability of a Contingency Plan and and no personnel with maintaining normal and alternate water systems in
61. Emergency maintenance and restoration of water supply systems
emergency procedure, maintenance and required or relevant water supply systems in emergency/disaster situations and
operational record, checklist conducting training emergency/disaster situations are personnel have been trained to
inspection, operations and maintenance not updated and personnel have maintain systems in both routine
manual, training certificates on how to no required or relevant training. and emergency /disaster
operate the pump. situations.
Check that:
- Maintenance personnel has proper training for emergencies
- Operation & Maintenance record is available
- Emergency procedure is available
3.3.4 Fire protection system

Partially meets requirements of the Meets requirements of the Fire

Fire Code of Philippines (RA Code of Philippines (RA 9514):
9514): Means of prevention and Means of prevention and
Does not meet
protection in place; Building has protection in in place; Building has
requirements of the Fire
62. Condition and safety of the fire protection (passive) system properly compartmentalized but properly compartmentalized and
Code of the Philippines
has no proper fire rating for doors, has proper fire rating for doors,
(RA9514).
windows, walls, and floors, no windows, walls, and floors, no
obstructive materials present along obstructive materials present
entrance/exit points. along entrance/exit points.

The hospital must be completely protected against fire, since this type of hazard can stop
services in a hospital when they are most needed. Hospitals are considered to be Availability of fire drawings and maintenance
buildings which are extremely difficult to evacuate; therefore, the most important aspect of records, fire plans, policies and procedures,
fire safety is to have the best means of prevention and protection in place. visible means of evacuation.
Passive fire protection measures will be based on the combustible level of each area,
the level of compartmentalization, the use of incombustible material, fireproof doors,
firewalls, and the location of doors and windows in respect to other buildings and other
areas. The main objective should be to prevent fires from starting and, if a fire starts, to
prevent its spread in order to avoid the total evacuation of the building.
Determine whether the hospital design incorporates firewalls, doors and designated
escape routes, which provide a high level of safety. Review the fire protection measures in
areas at highest risk of fire, including boiler rooms, fuel tank storage, medical gases,
electrical panels, electrical switch rooms, pharmacy etc from maintenance records, the
facility’s fire plans, and policies and procedures.
Partial evacuations should be prioritized, preferably to an area on the same level
(horizontal evacuation), and as a last resort to other floors (vertical evacuation). To enable
this, it is important to have a building structure that limits the risk of the fire spreading both
Fire or Smoke Detection System is
63. Fire/smoke detection systems
No system has been Fire or Smoke Detection alarm installed, well-maintained, and
installed. system installed but not tested. tested at least twice a year with
maintenance and testing records.
Check that: Availability of fire drawings and plans,
- Building is fully protected with fire detection & alarm system (smoke detectors, pull testing and maintenance record.
stations, & alarm bell)
- System is addresible (visual & audible)
- System is properly working or operational
- Inspection, Testin and maintenance record is available and updated
- Drawings, Operation & Maintenance manuals is available

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MODULE 3: Nonstructural safety Partial compliance with Fire Code

Compliant with Fire Code RA
9514:with automatic fire sprinkler
RA 9514:with automatic fire
system which includes fire
Non-compliant with Fire sprinkler system which includes fire
extinguishers, dry or wet
Code RA 9514Non- extinguishers, dry or wet
64. Fire suppression systems (automatic and manual) standpipes/risers, fire hose
compliant with Fire Code standpipes/risers, fire hose
cabinets including at least twice a
RA 9514 cabinets with at least once a year;
year maintenance and testing.
Visible and labelled fire suppression maintenance and testing. Fire
With updated Fire Safety
equipment, availability of testing and Safety Certificates not updated.
Certificates.
maintenance record, evidence of trained
Check that: personnel and fire drills conducted,
-The building has automatic fire sprinkler system availability of fire sprinkler, fire extinguisher,
- Portable fire extinguishers is accessible, clearly labelled, regularly maintained, and not fire hose cabinets.
expired.
- Dry or wet type standpipe/riser is adequate, available and accessible
- Inspection, testing and maintenance reocrds are available
- portable fire extinguishers are properly anchored, braced or secured.
- Fire safety personnel has adequate training
- Conducts fire drill regularly
Independent firewater tank with not
Independent firewater tank with not less than 30 minute-storage in
less than 30 minute-storage in operation fully compliant with RA
Not Compliant with
65. Water supply for fire suppression operation fully compliant with RA 9514 and NFPA 20. Maintenance
RA9514 of NFPA 20.
9514 and NFPA 20 but no testing done regularly;
Availability of fire drawings, plans, maintenance and testing done. maintenance and test records
inspection, testing and maintenance available.
records, facility policies and procedures,
Check that: firewater tank, fire pump, jockey pump and
- Fire reserved tank is adequate (minimum 30 minutes fire reserved) controllers.
- Fire reserved tank is dedicated for fire suppresion system
- Availability of water supply (e.g. river, lake, deepwell, external fire hydrants)
- Availability of drawings/plans, inspection, testing & maintenance reocrds
- Availability of facility policies and procedures

66. Emergency maintenance and restoration of the fire protection system Operation manual and preventive Operation manual and preventive
maintenance records and maintenance records and
No maintenance records emergency procedures for emergency procedures for Fire
and no personnel with maintaining Fire Protection System Protection System in
required or relevant in emergency/disaster situations emergency/disaster situations and
training. are not updated and personnel personnel have been trained to
have no required or relevant maintain systems in both routine
training. and emergency /disaster situations

Contingency plan and emergency

procedure, maintenance & operational
record, checklist for conducting inspection,
The maintenance division should provide the operations manual for the fire protection
operations & maintenance manual, training
systems, as well as records showing preventive maintenance of fire extinguishers and fire
certificates on how to operate the Fire
hydrants. Verify that:
Protection System; check for installation and
• A manual plus training on the management of fire protection systems are available.
connection to Fire Protection System, check
• There are records of preventive maintenance of extinguishers and hydrants.
functionality of sprinkler alarm control panel,
• The equipment is to be found in the appropriate places and is freely accessible.
controllers, expiration of fire extinguishers,
• The network of pipes, pumps and accessories is exclusively for the hydrants.
fire safety inspection certificates.
• Hoses are appropriately joined to the valves on the cabinets for the hydrants.
• The network of hydrants has its own water cistern.
• The fire safety officer (warden) team in the hospital has been established.
• Personnel are trained and drills have been carried out.
• A plan of action and procedures for fire response are available.
• Inflammable materials and liquids are stored in safe places that are reserved exclusively
for these substances.

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MODULE
3.3.5 3: Nonstructural
Waste management systems safety

With Sewage Treatment Plant With Sewage Treatment Plant

(STP), no leaks in the system but (STP); Effluent standard is
67. Safety of nonhazardous wastewater systems (Health Care Waste) No STP. has no latest laboratory waste compliant with DAO 35 with the
water result, or with test result but latest laboratory waste water test
not compliant with DAO 35. result; no leaks in the system.

Nonhazardous wastewater or sewerage systems consist of a network of pipes that carry

the wastewater from the hospital to the sewer unit or to a separate system. They also
include special systems such as septic tanks, infiltration wells and oxidation ponds, as well
as filters, hydraulic traps or siphons. These systems treat and dispose of residuals, Availability of drawings and inspection
prevent the entrance of odour or insects from the treatment or excreta systems, and record, DENR discharge permit,
unclog and clean the pipes. Certification of Analysis, Operational and
Ventilation systems maintain atmospheric pressure within wastewater systems. Grease, maintenance manual.
plaster, mud and sand must be filtered out to allow for the effective performance of
treatment and excreta systems.
Verify the physical and functional condition of equipment, clamps and anchors, the
means of discharge or evacuation, leakages due to defective or missing hardware, and the
state of the waste vents in covers. Look for leaks in the system and should assess the No inhouse STP but is directly
state of the registry (presence of faecal matter). Check overflows of deposits, the location connected and under MOA to Manila
of treatment tanks, pits and septic tanks, percolation of wells, grease, plaster or mud traps Water STP
and so on, and the proximity of wastewater systems to potable water systems, verifying
that the sanitation system lies downstream from the potable water system.
Ensure that facilities for hospital wastewater disposal do not have the possibility to
contaminate local serviceable drinking water. Evaluators should verify types of
independent or combined systems for water intake through the base of the system (drains,
showers, others) as a result of rain or flooding.Check the operation of the valves that
prevent sewage water from regurgitating back into the cistern, as well as the location of
the treatment systems in respect to the potable water management system. Visual
inspection can be supplemented by information from drawings, plans and site records..
Check if there are sufficient toilets (at least 1 per 15 patients and staff) that are
functioning and accessible and that safely separate the user from excreta.

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MODULE
68. 3: Nonstructural
Safety of hazardous wastewater andsafety
liquid waste (Health Care Waste)
Criteria for Evaluation:
- Separate collection of hazardous wastewater in accordance to Clean Water Act R.A. Hazardous waste are pre-treated
Hazardous waste are not
9275. n/a either through neutralization tank
pre-treated.
- Availability of proper records and maintenance or thermal treatment

The characteristics of each of the wastewater systems define the form of disposal and
whether the waste would be in conventional form or in a form that can be removed by the
authorized entity. The responsible division of the hospital (e.g. engineering or
maintenance) should ensure that hazardous wastewater does not drain into the public
sewage system and does not contaminate drinking water.
Dangerous residual liquids can be divided into two groups: those that are pre-treated
and which can then be discharged into the sanitation system, and those which cannot be Availability of proper records and
discharged and need manual removal by an authorized entity. In both cases the hospital maintenance, availability of drawings,
Manila Water do the treatments
must ensure the standards, and the system must be assessed according to the inspection record, operational and
maintenance manual, interview Pollution needed
established standards of the country.
Liquids that can be discharged into the sanitation system through pre-treatment include Control Officer (PCO).
oils and fats, explosive mixtures, colourings, corrosive waste and some radioactive
matters, depending on the level of concentration.
Liquid waste from operating rooms may be infectious if it has come into contact with
liquid or
semi-liquid substances such as blood, semen, vaginal secretions, saliva, purulent
secretions and placenta or cerebrospinal, synovial, pleural, peritoneal or amniotic fluid.
Other liquids that do not contain concentrations of drugs or radioactive substances can be
handled as nonhazardous liquids and may be discharged to community sewer systems.
The hospital sanitation system will track where the substances are discharged once
treated in order to obtain a sample for analysis to verify the safety of landfill material to the
environment or to determine possible action to ensure safety of the environment.

Management System is partially

System for solid waste Hospital practices proper
implemented; hospital practices
management does not segregation using color coded
69. Safety of nonhazardous solid waste system (Health Care Waste) proper segregation using color
exist or poorly containers; waste handlers uses
coded containers, but waste
implemented. PPE; With Central Waste Storage.
handlers does not use PPEs

Documented health care waste in all 5

stages- min, segration, collection, storage,
disposal.

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MODULE 3: Nonstructural safety

The responsible division of the hospital (e.g. engineering or maintenance) should ensure
that solid waste does not pollute the environment and does not cause any risk to health.
Like liquid waste, solid waste is classified as hazardous or nonhazardous with each
type treated differently. There are three important steps to the management of waste that
should be checked by evaluators, namely:
• Segregation or classification of waste. This is key as wrong classification can cause
problems
later and lead to loss of time. The level of preparedness of personnel and the
establishment of
biosecurity protocols must be checked, including the use of appropriate containers for Documented health care waste in all 5
different stages- min, segration, collection, storage,
types of waste – such as high-resistance red polypropylene bags for hazardous disposal.
substances,
sharps containers, containers for special elements, and black bags for nonhazardous
waste.
• Handling and storage. Personnel in charge of handling should know the different types of
waste and correct management. They should wear personal protective clothing and
equipment
and should adhere to the routes and schedules established. Nonhazardous materials can
be placed in areas served by the municipal services, separate from hazardous materials.
• Collection and transportation. Transportation to the place of final treatment or disposal
will be
in special, closed vehicles with specific timelines, leaving the collection area perfectly
clean.
Solid waste should be disposed of in a safe and proper manner in accordance with
appropriate legislation and guidance.

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MODULE 3: Nonstructural safety Management System is partially

Hospital practices proper
segregation and storage using
System for solid waste implemented; hospital practices
color coded containers; waste
management does not proper segregation using color
70. Safety of hazardous solid waste system (Health Care Waste) handlers uses PPE; Proper
exist or poorly coded containers, but waste
treatment, proper collection and
implemented. handlers does not use PPEs, no
Evidence practice of Proper healthcare transport with SMR , with Central
SMR.
waste management and monitoring using Waste Storage.
Check conditions in the followoing documents: quarterly Self-Monitoring Report (SMR),
-Segregation or Classification of Waste - Good Housekeeping, proper documentation of health care waste
documentation/monitoring management system procedure.
- Handling & storage of NonHazardous Solid Waste - Material Recovery Facility
(MRF)
- Collection and Transportation - accredited service provider by DENR-EMB
- Joint Administrative Order (JAO) No. 02, series of 2005, “Policies and Guidelines
on effective and proper handling, collection, transport, treatment, storage and
disposal of health care wastes” Also:R.A. 9003 - Philippines Ecological Solid Waste
Management Act of 2000

With Emergency Management Emergency Management Plan and

No available Emergency
71. Emergency maintenance and restoration of all types of hospital waste management Plan but no SMR; personnel have SMR are available; personnel have
Management Plan and
systems been trained on healthcare waste been trained on healthcare waste
SMR.
management. management.
Availability of Healthcare Waste
Management Plan, Quarterly Self
Monitored Report (SMR), Emergency
Management Plan for healthcare waste
management, evidence of trained
The maintenance division should provide the operations manual and preventive personnel.
maintenance records for hazardous solid waste management systems. Evaluators should
verify that there are emergency procedures for maintaining hazardous solid waste systems
in emergency/disaster situations. Waste management should be compliant with Joint
Administrative Order (JAO) No. 02, series of 2005, “Policies and Guidelines on
effective and proper handling, collection, transport, treatment, storage and disposal
of health care wastes”. Also RA6969 and RA9003 - Philippine Ecological Solid
Waste Management Act 2000 . Check that personnel have been trained to an
appropriate standard

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MODULE
3.3.6 3: Nonstructural
Fuel storage safety and diesel)
systems (e.g. gas, gasoline,
Sufficient for 24 hours or
Sufficient for more than 24 hours Guaranteed to cover at least 72
72. Fuel reserves less, or fuel tank does not
but less than 72 hours hours.
exist

Verify that the hospital has fuel supplies or storage tanks of adequate size and
safety.Verify the level of demand for fuel at the maximum capacity of the hospital, taking
into account the additional capacity required to respond to emergencies and disasters.
Check the size of reserve tanks to ensure that the reserve is sufficient to meet the demand Availability of fuel consumption records
for each type of fuel at the maximum capacity of the hospital for at least 72 hours with the (hourly consumption of fuel).
high increase in service demand in emergencies and disasters. Observe how much fuel is
available at the time of the assessment. Determine how often fuels are delivered and
whether supplies can be delivered effectively during emergencies or following disasters,
especially if access and road networks have been compromised. Hospitals that do not
have fuel reserves or fuel tanks and provided with fuel from petrol stations on a contractual
basis, for instance, should be given a low rating.

Safety ratings for item No.

Tanks are in good condition; No
73: Low = Tanks are in No presence of water; Tanks are in
presence of water in fuel tanks,;
poor condition; presence of fair condition, anchors and bracing
clearly labelled ; anchors and
73. Condition and safety of above-ground fuel tanks and/or cylinders water in fuel tanks ; there are inadequate tank enclosure has
bracing are in good condition; the
are no anchors or tank some safety and security
tank enclosure has adequate
enclosure; tanks are not measures.
safety and security.
safely located.

The fuels used for the generators, hospital boilers and other services may differ, so it is
important that all fuel tanks are very clearly labelled and, where possible, stored in
different areas. All fuel tanks should be well-anchored to prevent them from tipping. Visit
the fuel tanks and cylinders to determine the safety and security of the installations and
the tanks/cylinders, and should verify that the tanks/cylinders are safe and secure from
hazards (e.g. anchors, banded enclosures, safe from fire). Fuel tanks should be located at Availability of maintenance and inspection
least 2m away from power lines and from combustible elements such as weeds or dry records.
grass, in a radius of at least 3 metres. If tanks are located in publicly accessible places,
they must be protected by a security gate with a lock or padlock.
Where tanks/cylinders are supported by concrete or brick walls, the walls should be
checked for cracks and the braces or anchors checked for signs of sinking or general
deterioration. Large horizontal tanks can slide and break connection hoses, so in seismic
areas they should be supported with clamps and flexible connections. Evaluators should
check that there are appropriate isolation valves to ensure that fuel tanks can be isolated
in the event of damaged pipework.
It is important to keep in mind that the heavier the tank/cylinder and the higher its centre
of gravity, the greater is the likelihood that it will tip over. Cylinders positioned vertically
should be anchored/supported in at least three directions.

IF THE HOSPITAL DOES NOT HAVE THESE SERVICES, LEAVE BLANK.

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MODULE 3: Nonstructural safety

Clearly marked hazard specific
Meets the required distance but not
All conditions not metAll location, meets the required
74. Safe location of fuel storage away from hospital buildings clearly marked, not accessible, not
conditions not met. distance, accessible, well-secured
secured and has no lighting.
and has adequate lighting.

Presence of labels/marks posted in fuel

Check for: storage tanks location.
- Tanks are accessible and has proper labell
- Safe and stored in different areas (isolated from the main building)
- Properly provided with support, bracing and anchor
- Safe and secure from hazards (fire, banded enclosures), away from power lines
- Protected by a security gate with lock or padlock
IF THERE IS NO FUEL TANK, LEAVE BOXES BLANK.
No leakage in the system , in good
With leakage despite of No leakage in the system but has
operational condition and has
75. Condition and safety of the fuel distribution system (valves, hoses, connections) evidence of maintenance no evidence of maintenance and
evidence of maintenance and
and inspection records. inspection records.
inspection records.
Check for:
- Accessible clearlymarked and labelled
- Safe distance from key clinical and non-clinical facilities Availability of drawing, operation and
- If tanks are enclosed (built with non-combustible materials) maintenance manual and inspection
- Properly ventilated and well illuminated reports.
- Properly secured with fencing, CCTV, and with security alarm for intruder
- Accessible for maintenance and for emergencies
- Have a good draiange system
- Not prone to flooding, landslide or soil liquefaction
- Check if there is avalaible fire protection equipment (manual portable fire extinguishers
foam type or automatic fire suppresion system)
IF THERE IS NO FUEL DISTRIBUTION TANK, LEAVE BOXES BLANK.
Operation manual and preventive
Operation manual and preventive maintenance records and
maintenance records and emergency procedures for
No maintenance records emergency procedures for maintaining normal fuel storage
and no personnel with maintaining normal fuel storage systems in emergency/disaster
76. Emergency maintenance and restoration of fuel reserves
Availability of contingency plan and required or relevant systems in emergency/disaster situations and personnel have
emergency procedure, maintenance record, training. situations are not updated and been trained to maintain fuel
checklist for conducting inspection, personnel have no required or storage systems in both routine
operations & maintenance manual, training relevant training. and emergency /disaster
certificate on maintenance. situations.
Check for:
- Fuel distribution lines is in good conditions, no sign of leakage, deterioration
- Flexible connections is attached to the equipment
- Availability of inspection, testing and maintenance records
- Training records

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MODULE
3.3.7 3: Nonstructural
Medical gases systems safety
In good location, well ventilated,
In good location and accessible to well illuminated, accessible to
Not in good location and
authorized personnel but not authorized personnel, well-secured
77. Location of storage areas for medical gases did not meet other
secured and no protective and other protective measures
conditions/ criteria.
measures. (clearly marked and labelled) are in
place.

Check:
- Oxygen supply banks, as well as storage tanks of medical gases, should be located
outside the hospital building because of the risk of tank discharge and explosion.
- Verify that there is a site designated solely for storage of tanks and/or cylinders and
related equipment for medical gases, and that only this equipment occupies the
designated area. These areas should be well-ventilated, well-illuminated and clearly
marked and labelled.
- There should be secure enclosure around the site, with signage indicating that the gases
and equipment are dangerous.
- The location should be in an area unlikely to flood, at a distance from any heat sources
including fuel sump pits, and protected from flying or falling debris.
- The site should be easily accessible for facilities, maintenance and fire response
personnel.

Conditions not met Storage areas are in fair condition, Good condition, with separate
with separate areas for empty and areas for empty and full bottles,
full bottles, designated areas for designated areas for each type of
each type of gas but no signages ; gas, with signages, well-secured
the quality of anchors and braces and protected, anchors are of good
78. Safety of storage areas for medical gas tanks and/or cylinders is inadequate; with personnel quality for major hazards; with
trained on medical gas handling; personnel trained on medical gas
with fire extinguishing equipment. handling; with fire extinguishing
equipment .

Check:
- Visit areas where medical gas bottles, tanks and cylinders are stored to verify that Availability of drawings, maintenance and
they are safe and secure and that they are prevented from falling over and protected from inspection record, evidence of trained
hazards (e.g.obstacles, fire, anchors, braces). personnel.
- The size of the storage areas must also be adequate for the correct handling of bottles,
tanks and cylinders from deliveries. Each cylinder containing gas must have permanent
marks that show whether it has pure gas or a mix of gases inside.
- Storage areas should also show the types of risks and safety measures to be taken, so
that the necessary control actions are applied when manipulating the cylinders.
- The cylinders should not be painted. In earthquake-prone zones and high-wind areas,
medical gas tanks in storage areas should be wellbraced or anchored. If these tanks or
cylinders are stored in undesignated parts of the hospital, such as corridors, the rating
should be “low”.
- Ascertain that the personnel responsible for managing medical gases know all safety
procedures and isolation requirements for each type of gas being used.
- Fire extinguishing equipment must be available, and personnel must be trained in its use.

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MODULE 3: Nonstructural safety In fair condition; properly color In good condition properly color
coded and labelled; inadequate coded and labelled, properly
79. Condition and safety of medical gas distribution system (e.g. valves, pipes,
Conditions not met. anchorage and not protected, anchored and protected; bottle
connections)
bottle pigtails are flexible; No pigtails are flexible; No gas
leakage. leakage.

Verify that storage devices and distribution networks use colour-coding and labelling to
identify different types of medical gases. In addition to different colours, the bottles or
cylinders for each type of gas use different valve configurations, eliminating the hazard of
connecting the wrong type of gas to the supply. Availability of drawings, inspection and
The major danger if gas tanks fall is that the valves will break and there will be an maintenance records.
uncontrolled flow of pressurized gases escaping into atmosphere with dangerous
consequences. Inspect the operation of the retaining valves in the cylinder banks, outage
valves and intake points; ensure that couplings are flexible, and there is enough play to
tolerate small movement, but that tanks cannot fall or knock against each other while they
are connected to the supply bank. Tubing should be protected and correctly anchored to
structural elements. Flexible couplings should be used where tubing crosses structural
joints. It is important to examine the network for leaks. Check the alarm system, the
capacity of operators and the maintenance system, as documented in the maintenance log-
book and records.

Medical gas bottles are in fair Medical gas bottles are in good
condition; color coded; well condition, color coded, well
80. Condition and safety of medical gas cylinders and related equipment in the hospital Conditions not met.
ventilated; the quality of anchors ventilated , properly braced or
and braces is inadequate. anchored.

Gas bottles, tanks and cylinders are usually located in the service areas where they are
used. They contain a variety of gases that are under high pressure; some are toxic, others
Availability of procedures and hydro-testing
are flammable. In general, the gas containers should be well-ventilated, braced or
certificate of cylinders.
anchored to avoid damage to their valves if they fall, and to avoid injuring patients and
staff or damaging other equipment. Each oxygen outlet should have a valve that can close
the supply. Quick access to the premises is necessary and the location of the keys should
be clearly marked for authorized personnel to use.
Vertical oxygen tanks should be anchored in three or four directions with welded
connections, bolts or evenly spaced tie-downs; horizontal tanks should be anchored to
walls so they cannot slide as a result of shaking during seismic events. Medical gas
distribution pipes should have flexible connections when passing from building to building
or across expansion/ seismic joints in earthquake-prone regions.
Alternative sources in place but Sufficient alternative sources are
Alternative sources are not
81. Availability of alternative sources of medical gases delivery of supplies takes longer available at short notice (at least 3
available.
than 3 days. days).

Verify that alternative or standby sources for medical gases have an oxygen supply bank Availability of Supplier Contract,
with the necessary reserve capacity and have reserve cylinders or bottles organizational policies and procedures.
available.Confirm whether the supplier of medical gases is in the vicinity and has reserves
available to enable an appropriate supply chain in an emergency. Assessors can obtain
this information through supplier contract details and organizational policies and
procedures.

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MODULE 3: Nonstructural safety Emergency Procedures exist,

Documented procedures Documented emergency
maintenance/inspection records
and procedures exist,
are up to date, personnel have
maintenance/inspection maintenance/inspection records
82. Emergency maintenance and restoration of medical gas systems been trained, and resources (e.g.
records do not exist; no are up to date, personnel have
Availability of contingency plan and PPE, precautionary signage) are in
trained personnel and no been trained, but resources are not
emergency procedure, maintenance record, place for implementing emergency
resources. available.
checklist for conducting inspection, maintenance and restoration.
operations & maintenance manual, training
The maintenance division should provide the operations manual and preventive certificate on maintenance and operation of
maintenance records for the medical gas system.Verify that there are emergency medical gas.
procedures for maintaining the medical gas system in emergency/disaster situations.
Check that personnel have been trained to an appropriate standard to maintain the correct
level of safety of the hospital’s medical gas systems in both routine and
emergency/disaster situations.

3.3.8 Heating, ventilation, and air-conditioning (HVAC) systems

Boiler enclosures are not
Boiler should be in a safe location Boiler should be in a safe location
accessible and they are not
with enclosures some measures with enclosures isolated from fuel
83. Adequate location of enclosures for HVAC equipment located in a safe site; there
provide partial protection from storage and protected from
are no protective
hazards. hazards.
measures.

Enclosures for boilers should be located away from the hospital building. Preferably, they N/A
should be housed in installations with some roof cover, isolated from fuel storage, in areas
that are easy to access and difficult to obstruct or flood. When central air-conditioning units
are on the roof of buildings they should be protected from the weather. Any HVAC
equipment should be easy to access (obstacles to access should be cleared) and
positioned in locations that are protected from flooding.

HVAC equipment is not

accessible; no protective HVAC is accessible; some HVAC equipment is accessible,
84. Safety of enclosures for HVAC equipment measures for safe measures provide partial wide range of protection measures
operation and protection. in place.
maintenance.

Check for:-
- Equipment has proper enclosure (specially for rotating equipment)
- Accesible with enough space for maintenance
- Properly ventilated and illuminated
- Control panels is safe from water ingress
- Plant rooms equipped with fire extinguishing equipment and with emergency lighting

Good condition, well-secured and

protected from hazards (e.g.
HVAC equipment in fair condition;
anchors are of good quality);
some measures provide partial
HVAC equipment in poor regular maintenance and testing of
85. Safety and operating condition of HVAC equipment (e.g. boiler, exhaust) protection, but no regular
condition, not maintained. control and alarms conducted.Has
inspection and maintenance
back-up HVAC equipment for
recors.
Availability of Operation and Maintenance centralized air-conditioning,
Manual, drawing plans, inspection and availability of maintenance records.
testing and maintenance record.
Check for:
- Equipment are in good condition and well maintained
- Provided with proper bracing, support, anchoraged, vibration isolators/rubber pads, and
flexible connections
- Availability of drawings/plans
- Regularly inspected and tested
- Availability of inspection, testing, and maintenance records

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MODULE 3: Nonstructural safety Connections are flexible; brackets

Connections are flexible; brackets
Inadequate supports ; are installed with proper intervals
86. Adequate supports for ducts and review of flexibility of ducts and piping that cross are installed with proper interval
ducts are damaged and (no duct deflection/ sagging);
expansion joints but ducts/ piping are corroded/
corroded. exposed ducts/ piping are not
damaged.
damaged and not corroded.

All heating, ventilation and air-conditioning (HVAC) ductwork pipes should be in good
condition
and must be supported adequately by the building structure. In earthquake-prone areas,
there should be no possibility of horizontal movement. Connections should be flexible,
while the bracing should be rigid but should allow ductwork to move in three directions. In
areas of high winds, ductwork that crosses roofs should be anchored, and should be
placed above the level of the roof’s drains.
Check the distance between supports to ensure that there are no deflections caused by
the weight of the ducts, which could cause them to fall. Where internal ductwork is hidden
by false ceilings, ceiling tiles should be removed to check the ducts. Ductwork should be
flexible across expansion joints. Ductwork that crosses between blocks of buildings units
should be inspected to ensure that it is not damaged and corrosion has not started to
occur around the ducts adjacent to each block or building.

All pipes and valves are in good

condition(no leaks, well
All pipes and valves are in fair maintained, safe from hazard,
All conditions not met All
87. Condition and safety of pipes, connections and valves condition, (with leaks and provided with proper
conditions not met.
inadequate hangers and brackets). hangers/support, sway bracing,
anchorage, and flexible
connections, insulated piping).

Pipes should travel through conduits so that they are protected from humidity and Availability of inspection, testing and
corrosion when passing through walls or fixtures or where they breach a fire compartment. maintenance records.
Check that valves operate and should review the condition of pipes in kitchens, boilers or
other areas where there is steam to ensure that coatings or piping are protected. Check
that condensation will not affect the insulation of piping and that leaks from upper floors
will not affect elements and services below. Humidity can ruin false ceilings and other
hospital elements or equipment that come into contact with the piping.
Piping should have flexible connections where it crosses expansion joints of the
building, and spans from building to building in earthquake-prone areas or where it is
connected to a rigid piece of equipment. The pipes should be supported at a distance
from electrical panels or wiring. Safety valves or air valves for steam or for hot or room-
temperature water respond to seismic amplifications such as inverted pendulums, so they
should have lateral supports.

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MODULE 3: Nonstructural safety

Hangers and Brackets are in fair
Hangers / Brackets of Air-
Hangers and Brackets are condition; some measures provide
conditioning are in good condition
88. Condition and safety of air-conditioning equipment in poor condition and not partial protection (e.g. quality of
and well maintained , and safe
safe from hazard. anchors and braces is inadequate)
from hazard.
and safe from hazard.

Check the condition and safety of air-conditioning units which may be local or central,
compact or not. Central air-conditioning units may be compact or split with a fan coil unit.
As not all air-conditioning systems can accommodate all requirements of areas with very
high sanitation requirements (e.g. operating rooms, intensive care units) and other areas
of the hospital, check the physical and technical condition of the equipment, including its Availability of drawings, inspection, and
suitability for servicing the area where it is installed.. maintenance records.
Air-conditioning units are very heavy and are generally located in areas with ventilation,
such as on roofs, upper floors of the hospital, or floors dedicated to building machinery
and equipment. Because of their weight, air-conditioning units can significantly change the
behaviour of the structure. Unless they are well-secured or anchored, the units can move
or overturn and, as a result, can cause partial or total collapse of the building. Smaller split
systems have the evaporator inside and the compressor and condenser outside, on the
roof, patio or elsewhere. The outside equipment is vulnerable to strong winds and floods
and must be well anchored and located out of reach of water that would damage the
electrical system. Indoor units should be firmly anchored to structural elements; if they
should fall they could injure people or damage other equipment. The condition and safety
of window units or small portable units should also be checked.

89. Operation of air-conditioning system (including negative pressure areas) Negative pressure room With negative pressure room
ventilation system is Negative pressure room ventilation ventilation system and is isolated
LEFT BLANK IF NOT APPLICABLE (this is applicable for one of the local hospital SAN incorporated with the Air- system has no HEPA filters. from the air conditioning system
LAZARO HOSPITAL with Biological isolation room) conditioning system. provided with HEPA filters.

Evaluators should check the ability of the hospital to establish zones for the air-
conditioning systems to reduce the spread of infectious diseases or fire. If there are
negative pressure rooms in areas of high risk for infectious diseases, evaluators should
check that these zones can be isolated from the air-conditioning system.
Documented procedures Documented emergency Emergency Procedures exist,
and procedures exist, maintenance/inspection records
maintenance/inspection maintenance/inspection records are up to date, personnel have
90. Emergency maintenance and restoration of HVAC systems records do not exist; no are up to date, personnel have been trained on operation and
trained personnel on been trained but no resources for maintenance, and resources are in
Availability of operations manual and operation and implementing emergency place for implementing emergency
preventive maintenance records, maintenance. maintenance and restoration. maintenance and restoration.
emergency procedure, evidence of trained
personnel.
Check for:
- Availability of operations manual and preventive maintenance records
- Emergency procedure for maintaining HVAC systems
- Personnel is properly trained for maintenance and safety (normal operation & emergency
situations)

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MODULE
3.4 3: Nonstructural
Equipment and supplies safety
3.4.1 Office and storeroom furnishings and equipment (fixed and movable)
No shelving/contents
91. Safety of shelving and shelf contents Some shelving/contents fixed. All shelving/contents fixed.
fixed.
Verify that shelving (whether as shelving units or wall attachments) and its contents should
be safely secured from falling. Shelves should not pose an occupational hazard or be at
risk of falling in a hazard event. Check that they are located where they will not obstruct
emergency access, evacuation routes or emergency exits. Shelves of medical contents
should all have lips or railings to prevent bottles or other material from falling.
Verify that shelves are anchored to the walls and/or are braced and that the contents are
secured. Clinical areas, offices, libraries and clinical records archives commonly have
shelving units with glass doors. These units should be connected to each other and
unbreakable material should replace the glass. Where there are rows of high, free-
standing shelves, these must be anchored to the floor, connected to each other at the top
by ties that cross the room and attached to the wall at each end of the row of shelves.
Connecting the shelves increases lateral stability, lessening the chance that they will fall.
For tall shelving made of combustible material, the condition of lighting fixtures and wiring
near the shelves should be inspected.

No computers/printers All computers/printers fixed and

92. Safety of computers and printers Some computers/printers fixed.
fixed. safe from flooding.

Much of a hospital’s information is found on its computers. To ensure that a facility

continues to
function, computers and their contents must be secured against damage caused by
natural hazards.
Verify that computer tables are secure and will not move. If tables are on wheels, the
Direct observation and inspection
wheels should be in the locked position. Where there is raised access flooring that allows
computer wiring to run under the floor, the evaluators should check anchors to the
structural slab and vertical and horizontal bracing.
In hospitals which are at risk of flooding or heavy rain, computer centres and
computers, particularly servers, should be located where they will not be at risk of water
damage. Basements and ground-floor areas are particularly susceptible to flooding.
Sprinkler systems for firefighting systems may also damage computers and other
electronic equipment.

3.4.2 Medical and laboratory equipment and supplies used for diagnosis and
treatment
93. Safety of medical equipment in operating theatres and recovery rooms Not fully fixed. N/A. Equipment is in fixed and safe.

Verify that medical equipment is safely secured with respect to natural and otherhazards.
Operating theatres and recovery rooms should not be located where they are most
vulnerable to the effects of natural hazards, including flooding, earthquakes and winds.
Verify that lamps, equipment for anaesthesia and surgical tables are operational and
that table or cart wheels are all locked, and in turn should be secured to the operating
table when in use. Ceiling light fixtures in surgery should function, the hinges on the
extension arm should be properly adjusted, and fixtures should be well-anchored to
Direct observation and inspection
beams to prevent them from swinging. Braces, latches and castor brakes on all equipment
should be inspected.
Life support equipment should be completely anchored, eliminating the possibility of
disconnection from the patient. Flexible hoses and tubes with swivel connectors and
automatic shut-off valves should be used for connecting equipment to medical gases,
water or steam. Cables that connect equipment to a power source should pass through a
conduit so that they cannot tangle during rotational motion. Equipment should not be
placed above the patient. When not in use, equipment should be braced against a wall,
with brakes applied to carts and rolling tables.

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MODULE
94. 3: safety
Condition and Nonstructural
of radiology andsafety
imaging equipment Not fully fixed. N/A Equipment is fixed and safe.

Verify that radiology and imaging equipment is safely secured with respect to natural
hazards. They should be located where flooding cannot damage them.Verify that the
condition of X-ray equipment and carts holding the equipment is in good condition and is
secured; brakes for cart wheels must be functional. Where computed axial tomography
(CAT) scanners are used, verify that they function and safety measures are in place.
Operators should be familiar with all safety protocols for using the equipment. Criteria used
in this item (94) can be applied to other equipment that should be anchored. Direct observation and inspection
In earthquake-prone areas, adequate anchors for this heavy equipment are needed to
keep it from tipping or moving. The higher the centre of gravity of these items, the greater
the possibility they will tip over. Power connections and other connections should be
flexible; it is better for cables to be disconnected than to break. Hospital equipment is
highly sensitive to sudden changes in voltage (e.g. computed tomography scanner,
mammography equipment, excimer laser, magnetic resonance imaging scanner) so
evaluators should ensure that this equipment has voltage regulators and earth-grounding
to protect equipment from electrical discharge.

95. Condition and safety of laboratory equipment and supplies Not fully fixed. N/A. Equipment is fixed and safe.

The instructions to evaluators in items 93 and 94 should be taken in consideration when

evaluating
the condition and safety of laboratory equipment. When inspecting the laboratory,
evaluators should pay special attention to handling and securing biological samples.
Biosafety measures should be in place. If biological and chemical containers break or leak
at any time, technicians, patients or the laboratory itself could be contaminated. Further
safety measures may be required to protect laboratory equipment and supplies from Direct observation and inspection
movement or damage due to hazardous phenomena. Refrigeration units for laboratory
supplies should be inspected to ensure that they are in good order and their contents are
secured. In hospitals in earthquake-prone zones or high-wind areas, shelving used for
storage of laboratory supplies, including biological and chemical containers, must be well-
anchored (see item 93). There should be adequate fire protection items or systems
(extinguishers, standpipe systems etc.) and laboratory staff must be trained in operating
this equipment.

96. Condition and safety of medical equipment in emergency care services unit Not fully fixed. N/A. Equipment fixed and safe.

The instructions for evaluators in items 93 and 94 should be taken into consideration when
assessing the condition and safety of equipment in the emergency care services unit.
Evaluators should check that this equipment – which includes crash carts, oxygen tanks,
monitors etc. – is in working order and is secured.

97. Condition and safety of medical equipment in intensive or intermediate care unit Not fully fixed. N/A. Equipment fixed and safe.

The instructions for assessors in items 93 and 94 should be taken into account when
assessing the condition and safety of equipment in the intensive care unit. Evaluators
should check that basic and specialized intensive care equipment is in good working order
and is well-secured. This equipment includes life-support systems, ventilators,
resuscitation equipment, oxygen tanks, monitors etc. The most rigorous inspection should
be carried out in the quarantine units of the hospital because of the added hazards of
contamination or infection.

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MODULE
98. 3: safety
Condition and Nonstructural safety
of equipment and furnishings in the pharmacy Not fully fixed. N/A. Equipment fixed and safe.

The instructions for evaluators in items 93 and 94 should be taken into account when
assessing the condition and safety of equipment in the pharmacy. Refrigeration units for
medicine and other supplies should be inspected to ensure that they are in good order and
their contents are secured. In hospitals in earthquake-prone zones or high-wind areas,
shelving used for storage of medicines must be well-anchored (see item 93). Because
some materials in the pharmacy are flammable, there should be adequate fire protection
items or systems (extinguishers, standpipe systems etc.) and pharmacy staff must be
trained in operating this equipment. Measures should be in place to ensure that the
pharmacy is secured against theft.

99. Condition and safety of equipment and supplies in the sterilization services Not fully fixed. N/A. Equipment fixed and safe.

The instructions for evaluators in items 93 and 94 should be taken into account when
assessing the condition and safety of equipment in the hospital’s sterilization services (in a
unit or otherwise). assessors should check the condition of autoclaves and should review
the operator’s training in managing them in cases of emergency. Water leaks originating
outside the units and possible contamination of stored items are concerns in sterilization
units, so evaluators should determine whether there are water filtration systems on upper
floors, water outlets or, in the worst case, toilets that could contaminate stored items.
Proper labelling for routing sterile and contaminated equipment should be checked.
Evaluators must ensure that safety measures are being used for shelving and trolleys
where sterilized materials are stored (see item 92); materials can be contaminated if
shelves or trolleys tip over during a seismic event.
Autoclaves are heavy and they should be completely anchored in earthquake-prone
zones. Water supply to autoclaves should have flexible connections in earthquake-prone
areas. Evaluators must also ensure that fire protection items or systems are present
(including extinguishers, standpipe systems etc.) and that the staff are qualified to use
them. The proximity of doors and windows to the materials being sterilized should be
checked, as well as the materials used for the doors and windows

100. Condition and safety of medical equipment for obstetric emergencies and neonatal
Not fully fixed. N/A. Equipment fixed and safe.
care

The instructions for evaluators in items 93 and 94 should be taken into account when
assessing the condition and safety of equipment for obstetric emergencies and neonatal
care. While a hospital may not have specialized services for neonatal care, evaluators
should check that equipment and supplies are available for a basic level of emergency
care for obstetric emergencies and neonatal care. Check that equipment is in working
order and is secured. Specific neonatal equipment includes incubators, resuscitation
equipment, oxygen tanks, monitors etc. Sanitatioen and hygiene should be rigorously
reviewed in these units, particularly in birthing rooms, because of the vulnerable condition
of newborns. Doors and windows should be able to resist strong winds; if water penetrates
the area, specialized equipment can be damaged or destroyed. It is difficult to transfer
newborns to other areas of the hospital because of their vulnerability.

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MODULE 3: Nonstructural safety Equipment is lacking, is in Equipment is in fair condition and Equipment is in good condition, is
101. Condition and safety of medical equipment and supplies for emergency care for burns poor condition, or there are some measures provide partial well-secured and measures
no protective measures. protection. provide good protection.

The instructions for evaluators in items 93 and 94 should be taken into account when
assessing the equipment for emergency care for burns. While a hospital may not have
specialized services for burns patients, evaluators should check that equipment and
supplies are available for a basic level of emergency care for burns. Evaluators should
check that basic and/or specialized burn care equipment and supplies are in good working
order and well-secured. This equipment includes life-support systems, ventilators, oxygen
tanks, monitors, crash carts etc.

102. Condition and safety of medical equipment for nuclear medicine and radiation therapy Not fully fixed. N/A. Equipment fixed and safe.

The instructions for evaluators in items 93 and 94 should be taken into account when
assessing the condition and safety of equipment for nuclear medicine and radiation
therapy. Check the handling, condition and safety of samples. Supplies should be stored
in areas where they cannot fall or be hit by other objects. If containers break or leak,
technicians and patients could be contaminated. Further safety measures may be required
to protect equipment from movement or damage due to hazardous phenomena. Drums
used for radioactive waste must be in safe locations and have secure covers. Verify that
radiation sensors and chambers for handling samples function correctly, and that signs
indicate restricted areas. As in other areas of the hospital, fire-extinguishing equipment
should be checked and evaluators should verify that staff know how to operate it.

IF THE HOSPITAL DOES NOT HAVE THESE SERVICES, LEAVE BLANK.

103. Condition and safety of medical equipment in other services Not fully fixed. N/A. Equipment fixed and safe.

Many of the elements addressed in items 93 and 94 will be applicable in other services of
the hospital not already addressed. These could include infectious disease services,
cardiology, orthopaedics, paediatrics, maternity, physiotherapy etc. Evaluators should
carry out a review of the remaining areas, giving the most weight to areas that would
influence the overall functioning of the hospital.

Not compliant with Item

104. Medicines and supplies N/A. Met if compliant with Item 134.
134

Verify the level of demand for medicines and supplies at planned maximum capacity of the
hospital, taking into account the types of services provided by the hospital and the Availability of medicines and supplies
additional capacity required to respond to emergencies and disasters. Check if the inventory.
availability of medicines will cover this maximum demand for at least 72 hours to ensure
that the hospital can sustain the provision of services in an emergency or disaster. The
WHO List of Essential Drugs can be used as a reference.

Met if there is a documented

system to ensure continued
Not compliant with Item
105. Sterilized instruments and other materials N/A. sterilization of instrument. Supply is
134
guaranteed for at least 72 hours at
maximum hospital capacity.

Evaluators should verify the level of the demand for sterilized instruments at the hospital’s
maximum capacity, taking into account the types of services provided and the additional Availability of policy and procedure for
capacity required to respond to emergencies and disasters. Check if the availability of instrument sterilization.
medicines will cover this maximum demand for at least 72 hours to ensure that the hospital
can sustain the provision of services in an emergency or disaster. Evaluators should
confirm that the hospital has a supply of sterilized materials for use in an emergency
(evaluators can check the supply prepared for the following day), and that it has the
means to sterilize instruments and provide sterilized materials to cover maximum demand
for at least 72 hours.

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MODULE 3: Nonstructural safety Met if compliant with item 134

Not compliant with Item (system in place)Supply
106. Medical equipment specifically used in emergencies and disasters N/A.
134 guaranteed for at least 72 hours at
maximum hospital capacity.
Verify the existence and maintenance of medical equipment and instruments used
in the hospital specifically in emergencies – such as endotracheal intubation kits, chest Availability of medical equipment monitoring
drain sets, surgical sets, neck collars, backboards and pelvic binders, infusion/transfusion procedure/record.
sets, emergency obstetric kits, nebulizers, oxygen masks etc. Verify the level of the
demand for medical instruments at the maximum capacity of the hospital, taking into
account the types of services provided and the additional capacity required to respond to
emergencies and disasters. Check that the availability of instruments will cover the
maximum demand for at least 72 hours.
Not compliant with Item Met if compliant with Item 134
107. Supply of medical gases N/A
134 (system in place)

Verify the level of demand for medical gases at the maximum capacity of the hospital,
taking into account the types of services provided by the hospital and the additional
capacity required to respond to emergencies and disasters. Check that the availability of
medical gases will cover maximum demand for at least 15 days to ensure that the hospital
Availability of procedures and
can provide services in emergencies. Check the reserve capacity of each type of medical
policyAvailability of procedures and policy
gas used in the hospital, taking into account both the central supply bank and the cylinders
or bottles in areas of service. The 15- day supply standard is used because large
quantities of medical gases are required and deliveries of these gases tend to be
infrequent. Verify the existence of up-to-date emergency contact details (e.g. telephone
numbers, addresses) of medical gas suppliers. It is also important to confirm the frequency
of deliveries of gases.

All ventilators are not

108. Mechanical volume ventilators N/A. Met if all ventilators are working
working

Verify that an inventory of the quantity, condition and protocols for use of this equipment is
available (usually from the Hospital Emergency/Disaster Committee).Verify the level of
Availability of protocol, monitoring records
demand for mechanical volume ventilators at the maximum capacity of the hospital, taking
and inspection.
into account the types of services provided by the hospital and the additional capacity
required to respond to emergencies and disasters. Check that the ventilators available will
cover this maximum demand for at least 72 hours to ensure that the hospital can sustain
the provision of services in an emergency or disaster.

Met if there is a sufficient supply of

109. Electromedical equipment Not compliant with 134 N/A. ECGs, pulse oximeters and
defibrillators

Verify that an inventory of the quantity, conditions and protocols for use of electromedical
or clinical engineering equipment is available (usually from the Hospital
Emergency/Disaster Committee).Verify the level of demand for electromedical equipment Availability of protocols and inventory
(e.g. portable electrocardiographs, blood gas monitors, surgical cautery equipment, records.
syringe pumps, ultrasound machines) at the maximum capacity of the hospital, taking into
account the types of services provided by the hospital and the additional capacity required
to respond to emergencies and disasters. Check that the availability of electromedical
equipment will cover this maximum demand for at least 72 hours to ensure that the
hospital can sustain the provision of services in an emergency or disaster.

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MODULE 3: Nonstructural safety

110. Life-support equipment ICU not functional n/a
Met if a fully functional ICU is
equipped

Verify that an inventory of the quantity, condition and protocols for the use of
this equipment (e.g. defibrillators, ventilators) is available (usually from the Hospital
emergency/Disaster Committee). Verify the level of the demand for life-support equipment Availability of protocol and monitoring
at the maximum capacity of the hospital, taking into account the types of services provided records/report.
by the hospital and the additional capacity required to respond to emergencies and
disasters. Check that the availability of life-support equipment will cover this maximum
demand for at least 72 hours to ensure that the hospital can sustain the provision of
services in an emergency or disaster.

Met if there is a fully stocked crash

111. Supplies, equipment or crash carts for cardiopulmonary arrest No functioning crash carts Some functioning crash carts
cart for each ward

Verify that an inventory of the quantity, condition, locations and protocols for
the use of this equipment and of supplies for managing cardiopulmonary arrest is available
(usually from the Hospital Emergency/Disaster Committee). Evaluators should verify the Availability of protocols and monitoring
level of the demand for cardiopulmonary arrest at the maximum capacity of the hospital, records.
taking into account the types of services provided by the hospital and the additional
capacity required to respond to the most likely emergencies and disasters. Evaluators
should check that the availability of these supplies and equipment will cover this planned
maximum capacity for at least 72 hours to ensure that the hospital can sustain the
provision of services in an emergency or a disaster.

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