Maintains knowledge of current regulatory guidelines applicable to the environment of care and life safety such as NFPA, Joint Commission, DNV, and CMS Conditions of Participation.
Conducts Infrastructure audits according to assigned schedule. Conducts Infrastructure audits every 6 months in patient care areas, annually in non-patient care, business occupancies, and documents communication and corrective actions.
Evaluate an individual’s knowledge related to environment / life safety compliance issues and physical safety of the staff, patients and visitors during facility audits.
Allocates time during visits to all hospital campuses to tour and document compliance issues in unassigned spaces such as common waiting areas, business and clinical corridors outside of department boundaries, areas leading to and from hospital buildings, parking lots and garages, and mechanical spaces not inside a department or unit.
Completes data entry.
Evaluates effectiveness of processes and reports non-comformities to the unit leadership
Maintains flexibility in response to emergency situations communicated by the department director in support of the hospital safety and facilities departments and inspects, educates, and enforces new and existing safety practices in support of performance improvement initiatives.
Presents findings to leadership as needed.
Participates in designing/developing audit tools and in developing schedules for audit process.
Participates in Accreditation Department meetings to share compliance issues with established standards or regulations, and identifies opportunities for improvement.
What Will You Need:
EDUCATION AND EXPERIENCE REQUIRED:
Minimum of 3 years experience in facilities management, inspection, or safety audits
Knowledge of regulatory standards and, once hired, AdventHealth policy and procedures with ability to interpret standards with respect to hospital operations.
Knowledge of the National Fire Prevention Association (NFPA) Life Safety Codeand interpretation with applicability to hospital operations.
Ability to handle multiple tasks simultaneously
Ability to articulate and educate regulatory information in a language understandable to staff at all levels in the organization
Sound written and verbal communication skills as evidenced by written reports and communications and oral educational conversations.
Computer proficiency in Microsoft office products
Knowledge and application of basic audit principles in a healthcare environment
EDUCATION AND EXPERIENCE PREFERRED:
Associate’s or Bachelor’s degree - Industrial Health and Safety Engineer, Construction Management
Experience with DNV accrediting body and basic ISO 9001 principles
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
Florida Class “E” Driver’s License
LICENSURE OR REGISTRATION PREFERRED:
OSHA OTI 502 (Construction)
OSHA OTI 503 (General Industry)
CHEM (Certified Healthcare Environmental Manager)
CHSP (Certified Healthcare Safety Professional)
The Internal Infrastructure Auditor works in collaboration with administration, physicians, facilities, ancillary, and clinical staff to improve support of patient safety and quality through audits, and reporting of compliance with codes and requirements related to our environment of care. Is actively involved in performing environmental and life safety audits to ensure that the organization is in a constant state of compliance and safety readiness. Serves as a resource to current related regulatory compliance standards and provides education to maximize the safety of the environment. Adheres to the AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.