Ae ntecgtatnnt meee =O csani = Ane Acad tale gnenat iad 7. Facility Management and Safety Surveyor (Closed Session) 1. | Evidence that the Leadership Supporting Hospital | 0.2.7 safety 2. | Evidence for Reporting Medical Supplies Adverse | LD.23.7 Effects 3. | Documents Reflecting implementation ofSafe | (D238 ‘Management of Medical Supplies and Devices Process 4. | Periodic Departmental Performance W316 Improvement Reports 5._| Hospital Budgeting Process FMS.1.4 6. | Documented Communications from the FMS FMS.2.4 Program Director 7._| FMS Departmental Organization Chart FMS.2.1 '8._| Annual Departmental Plan (bs.9 9. | Departmental Organization Chart 0.26.4, 1026.2 10. | Departmental Scope of Services 10.271, 0.28.2 11. | Departmental Mission Statement i281 12. | Departmental Manual 1029.1 13. | Multidisciplinary Policies 1029.2 1030.1 18. Approved Safety Management Program with clear | FMS.1.1, FMS.1.3 program components, goals, objectives, training ‘methodology, revision approach and outcome indicators. 191 | Radiation Safety Policy FMS9.1 20. | FMS Departmental Organization Chart FMS.2.3 21 a Liaison Officers List FMS.2.5 22.| Procured Furniture Specs Sheet FMS 23.| OR Fire Drill Report ‘OR.13.5 24. | Fire Walls Floor Layout FMS.19.3 25. | Fire Safety Training Schedule FMS.19.5 26. | Fire Extinguishers Inventory and Distribution FMS.20.1 27. | Fire Extinguishers inspection Reports FMS.20.4 28. | Fire Alarm Inspection Schedule and Reports FMS.21.1 29.| Fire Alarm Testing Schedule and Reports FMS.21.2 30. Fire Alarm Maintenance Schedule and Reports | FMS.21.3 31, | Fire Alarm System Distribution FMS.22.4 32.| Sprinkler System Inspection Reports FMS.22.1 33. Clean Agent System Inspection Reports FMS.22.2 34.| Wet Chemical System inspection Reports FMS.22.3 Page 82 of 131. 24-3-2016ees Sete. = Ocean poses 35.| Stand Pipes and Hose System Inspection Reports Pea satis Menetclniataatesgonent ed FMS.22.4 '36.| Policy for No Smokir FMS.24.1 meee '37.| Valid Saudi Civil Defense License FMS4.1 '38,| Saudi Civil Defense Report and Action Plan FMS.4.2 39,| Policy for Construction, Renovation, or FMSS.1 Demolition Bei eae 440. Policy for Preventing Children and Neonates FMS.113 ‘Abduction ‘41 | Policy for Lost and Found items FMS113 442. Policy for Safe Keeping of Patient Belongings FMS.113 ‘43. Policy for Involvement of Police in Certain Cases _| FMS.113 124 | Policy for Incidents of Violence FMS.41.3 ‘45. Policy for Women and Child Abuse FMS.11.3 46. Staff Security Training Schedule and Records FMS.114 47.| Policy on How to Deal with a Bomb Threat FMS.12.1 48, | External Disaster Plan FMS13.4 .49,| internal Disaster Plan FMS.13.4 50, £MS.13.4 Si Policy for No Smoking Security Rounds Pol FMS13.6 52.| KACST License for Radicactve Materials FMS9.3 '53,| TLD Monitoring Records, FMS9.7 See ee Fe 55. | Sample of Hazardous Materials Inve FMS.14.2 56. Hazardous Materials Exposure Report FMS146 '57| Waste Management Plan FMS.15.1 58. | Oncology and Radiotherapy Quality Control ‘ORT.10.1, Records External Disaster Management Pian '59,| Extemal Disaster Plan and Action Cards FMS.16.1 “60.| External Disaster Drill Report FMS.162 (abe ne aae 61.| Ambulance Function Log book FR.I5.6 62,| internal Disaster Plan FMS.17.1, FMS.18.5 ‘63. | Sample of Department-Specific Disaster Plan FMS.17.2 ‘64, Fire Drills Schedule FMS.18.1 ‘65. Fire Dri FMS.18.2, FMS.18.3, FMS. Poet 66, | Departmental Staffing Plan FMS.25.1 667,| Dialysis Equipment Maintenance Plan and HM6.2 Records 68.| Biomedical Equipment Management Plan FMS252 ‘69.| Medical Equipment Maintenance Schedule FMS.25.2 70,| Sample of Corrective Work Orders FMS.25.2 71.| Medical Equipment inventory list FMS.25.2 72.| Sample of Preventive Work Orders FMS.252 Page 83 of 131 24-3-2016a @ Toy) —— (Titer nto Ain chins aie grneash pad 73.| Medical Equipment Performance Statistical FMS.25.6 Reports 74,| Service Reports for Contracted Maintenance FMS.25.7 Services 75.| Department Specific Medical Equipment Failure | FMS.25.9 ‘Back-up plan 76.| Medical Equipment Upgrading/Replacement Plan | FMS.25.10 77.| Policy for New Equipment inspection FMS.26.1 78.| Policy for Proper Tagging of Medical Equipment __| FMS.26.2 79.| Policy for Removal of Equipment from Service | FMS.26.3, ‘80. | Policy for Agent and Contractors Repairs FMS.26.4 81.) Policy for Eliminating the use of Electric Extension | FMS.26.5 Cords '82._| Policy for Use of Cellular Phones in Critical Areas | FMS.26.6 '83./ Safe Operation of Medical Equipment Training | FMS.27.3 Records ‘84. Preventive Maintenance Plan QM.20.1 '85.| License for the Provision of Radiotherapy Services | ORT.2.1 from Relevant Authorities .| Utility Management Plan Incl FMS.28:2, FMS.28.3 '87.| Annual Testing of Utility Fail Action. | FMS.28.4 Plan ‘88. | Evidence of implement janagement _| FMS.28.5, FMS.37.1, FMS.37.2 Plan > ea ecg [a 90. Thera Inspection Reports FMS.30.2 91. | Emergency Circuit Diagram. FMS.31.1 ‘92.| Generators Maintenance and Testing Records | FMS.31.2 ‘93. Medical Gas System Testing Schedule and Reports | FMS.32.1, FMS.32.3, ‘94, | Policy and Procedure on Effective Use of Medical | FMS.32.2 Gas System 195. | Policy for Handling Various Types of Compressed | FMS.33.1 Gases ‘96. HVAC System Maintenance Schedule FMS.34.1 '97.| HVAC System Maintenance Records FMS.34.2 ‘98. | Periodic Preventive Maintenance (PPM) Records _| FMS.34.3, FMS.39.2 ‘99. HEPA Filter Monthly Monitoring Records 100] Air Change Per Hour Monitoring Records 101 Evidence of Air-Flow/Pressure Monitoring FMS.35.1, FMS.35.2, FMS.35.3, FMS.35.4, FMS.35.5, FMS.35.6, FMS.35.7, FMS.35.8, FMS.35.9 1102] Professional Code of Sewage Handling and FMS.38.1 ' Disposal 104 Laundry Equipment Maintenance Schedule and | FMS.39.1 Records 1104 Engineering Control Records FMS.39.2 1105, Kitchen Equipment Maintenance Schedule and FMS.39.2 Records Page 84 of 131 24-3-2016SE Ocsan of veut 106, Kitchen Cold Rooms Temperature Monitoring Log_| FMS.39.2 Aeneas as ates gone id and Records 1107) Microwaves and Ovens Maintenance Schedule | FMS.39.2 Dialysis Equipment Operation Manuals Facility Management and Safety Surveyor (Units Documents) Dialysis Equipment Maintenance Pian and Records Dialysis Equipment Maintenance Folder Dialysis Staff Training Records Biomedical Equipment Management Plan Water Treatment and Distribution Maintenance Records mi] > Jon] / ye | | ‘Water Quality Check Policy Ce fire |8. | Oncology and Radiotherapy Safety Plan Poe 14. _| Safe Operation of Medical Equipment Training Records 15. | Departmental Stafing Plan Poge 8S of 131, 24-3-2016