Brian Anderson
banderson@csm-institute.com
954-204-5428
"Improving the Day to Day of Athletic Healthcare"
BOC Facility Principles Survey 
This survey is designed to determine the compliance with the BOC Facility Principles published in April of 2013.  Please note that not all principles are addressed.  Please Respond to Each Question

Demographics:

​Setting:

State:

School (Optional): 


Introduction:

Is your program EXEMPT from state or federal OSHA regulations?

Is your program EXEMPT from compliance with Title IX?

Are student athlete / patient health records managed in paper or electronic format?


Accessibility:

Athletic training facility is EXEMPT from federal ADA requirements?

Athletic training facility is accessible according to ADA regulations:

     Doorways are adequately wide (32 inches for single doors and 48 inches for double doors)?

     Ramps and handrails are installed?

     Door assists are available?


Privacy and Confidentiality:

Employee education about record storage and handling of confidential patient information is available (i.e., FERPA and HIPAA)?

Communication to employees about record storage and handling of confidential patient occurs?

Evidence of the above communication is documented?

All interactions between patients / athletes and ATs or other healthcare providers are documented in the health records of each patient / athlete and 

securely maintained?

The facility has a locked file cabinet for all patient medical / health files?

There is a place to have private conversations with athletes and / or their parents?

Communication occurs with employees about their responsibility for ensuring the confidentiality of healthcare information?

Evidence of the above communication is documented?


Employee Safety

Bloodborne Pathogens:

Employee education about blood borne pathogens is sufficient?

Communication to employees occurs on a regular basis?

Evidence of the above communication is documented?

Personal Protective Equipment:

Personal protective equipment is available for employees?

Employee education and information is sufficient?

Communication to employees about the required use of personal protective equipment occurs?

Evidence of the above communication is documented?

Disposal of Potentially Hazardous / Contaminate Materials:

Employee education for disposal of biohazardous or sharps materials is sufficient?

Separate containers or receptacles for the disposal of biohazardous materials are available within the athletic training facility?

Hand Washing:

Adequate facilities for hand washing or hand sanitation are available throughout the athletic training facility?

Employee education about hand washing and personal sanitation is sufficient?

Open-toed Shoes:

Employee education information is sufficient that health care providers should refrain from wearing open-toed shoes to facilitate a clean and sanitary 

facility?

Electrical Safety:

Electrical outlets near water sources have ground fault interrupters (GFIs)?  

Electrical devices and GFI outlets used near water sources are inspected annually by appropriately licensed/certified 

electricians/ technicians?

Devices such as ultrasounds, electrical muscle stimulators or other units used on patients are inspected and calibrated annually?

Inspection and calibration are documented and archived per the organization's document retention policies?

Walking / Working Surfaces:

Warning signs are available when surfaces pose a hazard?

Patient Safety and Supervision:

Communication to employees occurs regarding the requirements for line of sight to patient treatment areas and supervision of patients when in the 

athletic training facility?

Evidence of the above communication is documented?

Reporting Adverse Medical Events: (An adverse medical event causes an injury to a patient as the result of a medical intervention, rather than the underlying medical condition.  Rules and regulations for the reporting of any adverse medical events within the facility must be documented.)

Communication to employees occurs regarding the reporting and documentation of any adverse medical events within the 

athletic training facility?

Evidence of the above communication is documented?

Storage and Handling:  Rules and regulations address the handling and storage of any potentially hazardous materials within the athletic training facility including, but not limited to, compressed gas / oxygen containers, gasoline, granular / liquid chlorine / bromine, ozone, aerosol cans, collodian, wet-acid batteries and ethyl chloride.  Material Safety Data Sheets (MSDS) - These display information on hazardous materials within the facility.

Potentially hazardous materials are properly identified?

Potentially hazardous materials are properly stored?

Material Safety Data Sheets are properly displayed within the facility?

Emergency Action Plan (EAP):

An EAP is developed for each facility / venue where injuries may occur?

EAP is communicated and practiced / drilled by employees?

Evidence of the above communication is documented?

Means of Egress and Exit Routes:  

Egress and exit routes are posted for each facility?

Communication of egress and exit procedures to employees occurs?

Evidence of the above communication is documented?

Display of Licenses, Certification and Professional Standards:

Current state licenses and certifications of all employees are displayed within the facility?

Annually, the appropriate supervisor or administrator verifies the license and certification status of each AT with the appropriate licensing / 

certification agencies (state AT Board, BOC)?

The appropriate supervisor ensures that each AT practices in accordance with the BOC Standards of Professional Practice?

The appropriate supervisor ensures that each AT practices in accordance with the appropriate state licensing regulations?








Yes NoDon't Know
Yes NoDon't Know
PaperElectronic
Yes NoDon't Know
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo