Commissioning Certificates by zqu23786

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									                                                            Building Operational
                                                                Status Checklist

                                                                                        EF2
This form relates to the architectural drawings, commissioning certificates, test data and
other documents that should be available onsite for inspection if required for the type of
service to be registered. Please note that the Care Quality Commission may request that
you submit copies of all or some of the following relevant documents as part of the
registration process.

This form must be completed and submitted at least 10 days before a site visit. A site
visit will be at least 14 days before you wish to commence the service(s) subject to
registration.

Name of establishment: _______________________________________________

Name and Status of person completing this form: ____________________________

Status: _______________________________ Date Completed: ________________


Premises                            Please tick which of the Date of        Assessors
                                    following documents      issue          Comments
                                    are available for
                                    inspection
                                    Yes          No
As Built Drawings
As Fitted Drawings Architectural
As Fitted Drawings Mechanical
As Fitted Drawings Electrical
As Fitted Drawings Medical
Gases
Mechanical Engineering Services
Operation &Mechnical Manual
Electrical Engineering Services
Operation &Mechanical Manual

If no is ticked please state why on the variance form below

Please list the                     Please state the reason       What action if any do you
drawings/documents not                                            propose to take?
available for inspection




Copies of Commissioning             Please tick which of the Date of        Assessors
Electrical Certificates             following certificates   issue          Comments
                                    are available for
                                    inspection
                                    Yes           No
Calibration and Testing
Equipment.
Form EF2                                                                                      1
February 2008
                                                                Building Operational
                                                                    Status Checklist

                                                                                           EF2
Electrical Installation (+test data)
Emergency Electrical Installation
(+test data)
General Lighting System (+test
data)
Emergency Lighting System
(+test data)
Fire Alarm & Detection Systems
(+test data)
Security Systems (+test data)
Telephones & ICT Systems
Emergency Call Systems (+test
data)


If no is ticked please state why on the variance form below

Please list certificates not available   Please state the reason      What action if any do you
for inspection                                                        propose to take?




                                         Please tick which of      Date of     Assessors
                                         the following             issue       Comments
Commissioning Mechanical
                                         certificates are
Certificates for:
                                         available for
                                         inspection
                                         Yes         No
Heating Systems (+ test data)
Ventilation Systems (+ test data)
Microbiological Test results (3 & 14
days)
Domestic Gas Installation
Domestic Fuel Oil Installation (test
data)
Domestic Cold Water System & Hot
Water System Installation
Process Water Installation (+test
data)
Water Chlorination
Medical Gases installation &
Approved Person -MG Report
(+test data)
Medical Gas Purity & Quality
testing
Acoustics
Washer Disinfectors and Sterilizers
& Approved Person Report (+test

Form EF2                                                                                          2
February 2008
                                                        Building Operational
                                                            Status Checklist

                                                                                  EF2
data)
Cold Rooms
Boiler Plant
Refrigeration Plant
Laboratory Gases
Fume Cupboards



Other Mechanical Services as Required

If no is ticked please state why on the variance form below

Please list certificates not      Please state the reason     What action if any do you
available for inspection                                      propose to take?




Protocols & Procedures to         Please tick which of the Date    Assessors Comments
confirm emergency action for      following certificates   of
failure of:                       are available for        issue
                                  inspection
                                  Yes           No
Water
Gas
Electricity
Telephones


If no is ticked please state why on the variance form below

Please list the emergency         Please state the reason     What action if any do you
protocols/procedures not                                      propose to take in the event
available for inspection                                      of these potential
                                                              emergencies?




Other Data:                       Please tick which of the Date    Assessors Comments
                                  following certificates   of
                                  are available for        issue
                                  inspection
                                  Yes           No
Town Planning consent and
evidence of discharge of all
relevant planning conditions
Building Regulations approval

Form EF2                                                                                  3
February 2008
                                                            Building Operational
                                                                Status Checklist

                                                                                      EF2
Radiation Protection Adviser’s
approval of radiation protection
and details of workload for which
this approval applies
Evidence of environmental health
approval for all food preparation
areas requiring it.
Evidence of Home Office
approval of arrangements for
storage of controlled drugs.



If no is ticked please state why on the variance form below

Please list data not available for   Please state the reason      What action if any do you
inspection                                                        propose to take




Please specify what Health Technical Bulletins and/or Health Technical Memorandum or
Health Facilities Notes you have applied to the design and construction of your
premises and summarise any derogations (using a separate sheet if necessary) from
these documents that you have adopted.


Register of mechanical and technical equipment

A register of mechanical and technical equipment is available for inspection Y   N
(Please circle as applicable).


I hereby declare that the information detailed in this document is to the best of my
knowledge true and accurate.

I understand that Section 27 of the Care Standards Act 2000 makes it an offence for
an applicant to knowingly make a statement which is false and misleading in a
material respect in any information or documents submitted with this application for
registration / to vary conditions of registration [delete as appropriate].

In making this declaration to the Care Quality Commission, I confirm / I confirm on
behalf of my partners / on behalf of my organisation [delete as appropriate] I/we
[delete as appropriate] have met the relevant National Minimum Standards. I
understand that non-compliance with all relevant legislation and guidance may lead
to a refusal of this application.

Signed                                      Position

Date


Form EF2                                                                                      4
February 2008

								
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