CHFM Certified Health Care Facility Manager (CHFM) Question and Answers

The Hazard Vulnerability Analysis (HVA) is the primary tool recommended by The Joint Commission (TJC) for planning emergency response exercises. It allows facilities to identify, assess, and prioritize potential hazards and then plan drills and exercises accordingly.

C. HVA (Correct): Standard TJC requirement for developing emergency exercises.

A. ILSM (Interim Life Safety Measures): Used during construction or when life safety features are impaired, not for emergency planning.

B. PCRA (Pre-Construction Risk Assessment): Focuses on infection control and safety risks during construction.

D. ICRMR: Not a recognized TJC tool.

Builder’s risk insurance is first-party property insurance that covers physical loss to the work under construction, including the replacement or repair value of a structure and materials during the construction period. It does not provide workers’ compensation (A), payment bond protection for subcontractors (B), or performance/contractor default liability (D). Those are separate coverages (workers’ comp, payment bond, performance bond).

Per NFPA 101: Life Safety Code, soiled linen and trash containers greater than 32 gallons are not permitted in patient rooms or at nurse stations. Containers larger than this must be located in designated hazardous areas with proper fire protection.

C. 32 gal. (Correct).

Smaller values (8, 16) are permissible but not the regulatory maximum.

D. 64 gal.: Exceeds NFPA maximum and requires special room design.

Step 1: Calculate utility cost per square foot.

$1,200,000 ÷ 500,000 sq. ft. = $2.40 per sq. ft.

Step 2: Calculate new total square footage.

500,000 + 100,000 = 600,000 sq. ft.

Step 3: Projected utility cost.

600,000 × $2.40 = $1,440,000

Thus, the anticipated utility budget after expansion is $1,440,000.

For a single-user office, the most cost-effective and functional choice is a key lock. Other options (keypad, badge, biometric) are appropriate for higher-security or multi-user access points but are excessive in cost and complexity for one occupant.

B. Key lock (Correct): Meets the requirement simply and inexpensively.

A. Keypad lock: Adds unnecessary technology and cost.

C. Biometric lock: High cost, appropriate for sensitive areas only.

D. Badge access lock: Requires system integration and ongoing management not justified for a single office.

The Joint Commission (TJC) aligns with NFPA 101: Life Safety Code. For business occupancies (such as outpatient clinics), the requirement is that fire drills be conducted annually (every 12 months).

Quarterly (every 3 months) drills are required for healthcare occupancies (hospitals, nursing care).

Outpatient business occupancies are less stringent.

The simple payback period is calculated by dividing the initial investment cost by the annual operating savings (reduction in operating cost). It does not consider time value of money, inflation, or full life-cycle costs.

A (Correct): Annual operating cost directly determines the annual savings, which is essential for payback calculation.

B: Inflation is considered in more advanced financial models (e.g., NPV, IRR), not simple payback.

C: Replacement cost is relevant for life-cycle cost analysis, not simple payback.

D: Life of the equipment may determine feasibility but is not part of the basic payback formula.

Prior to occupancy of newly constructed healthcare space, the local fire department (or fire marshal) must perform a survey/inspection to ensure compliance with life safety requirements, fire alarm functionality, sprinkler coverage, and egress standards. This is part of code compliance and occupancy approval.

NFPA 80 (Standard for Fire Doors and Other Opening Protectives) sets requirements for fire door construction and installation. It specifies that the maximum undercut clearance is 3/4 inch unless otherwise tested and listed. Greater clearances compromise the integrity of the fire barrier.

NFPA 72, National Fire Alarm and Signaling Code, is the controlling standard for inspection, testing, and maintenance (ITM) of fire alarm and signaling systems (see the ITM chapter—commonly Chapter 14). It details testing frequencies, procedures, and documentation requirements for initiating devices, notification appliances, control equipment, and interfaces.

In healthcare facility maintenance, institutional standards are established to improve consistency, reliability, and efficiency in operations. Ball valves are often chosen over gate valves because they are available in standardized sizes, have fewer variations, and simplify inventory management. This allows facility departments to reduce the number of spare parts stocked and streamline repairs. The CHFM exam reference materials, including ASHE/AHA guidelines, highlight that “ease of inventory control and standardization” is a common justification for selecting one type of valve as a facility standard.

OSHA’s Control of Hazardous Energy (Lockout/Tagout) standard, 29 CFR 1910.147, requires that each authorized employee shall affix a personal lockout device to the energy-isolating device when they are working on equipment. This ensures that energy cannot be restored until every individual has removed their own lock, thereby directly protecting each worker.

Correct (D): The standard explicitly describes the use of a multiple lockout device (commonly called a hasp), where each employee applies their own personal lock. No lock may be removed until the individual’s work is complete.

Incorrect Options:

A: Listing multiple names on a single lock/tag does not meet OSHA’s requirement for individual control.

B: Providing multiple keys to a single lock defeats the purpose of individual energy control and is not compliant.

C: Commonly keyed locks are prohibited because one employee could remove another’s lock.

Relevance to CHFM Exam (Compliance Domain):

The CHFM exam tests knowledge of OSHA workplace safety standards because healthcare facility managers must ensure compliance in utility and maintenance operations. Proper lockout/tagout procedures are critical for worker safety and regulatory adherence.

According to federal and state healthcare waste management standards, regulated medical waste must always be separated from general waste streams at the point of generation. Proper segregation ensures compliance with OSHA’s Bloodborne Pathogens Standard, EPA’s Resource Conservation and Recovery Act (RCRA), and The Joint Commission’s Environment of Care standards. Containers for regulated waste must be red, leak-resistant, and labeled with the universal biohazard symbol.

Correct Answer (D. separated from other types of waste): CHFM compliance and Environment of Care standards require that infectious or hazardous medical waste be physically separated to prevent cross-contamination and maintain compliance with infection control protocols.

A (labeled with specific content): While containers must be labeled, they do not list specific contents; only the biohazard designation is required.

B (refrigerated at 40°F): Refrigeration applies only in specific storage conditions, not universally required for all regulated medical waste.

C (incinerated within 10 days): Time requirements vary by jurisdiction; incineration within 10 days is not a universal federal mandate.

The Safe Medical Device Act (SMDA) of 1990 requires healthcare facilities to report to the FDA and the manufacturer when a device is suspected of causing or contributing to death or serious injury.

C. death or injury (Correct): Specifically mandated under SMDA.

A. inappropriate application: A usage issue, not a reporting trigger.

B. recall: Issued by the FDA/manufacturer, not the facility’s reporting obligation.

D. major breakdown: Requires service but not mandatory reporting.

Submittals and shop drawings are specifically reviewed to ensure compliance with the design intent, plans, and specifications prepared by the architect/engineer. Code compliance is established during design and permitting, while minimizing change orders or ensuring contractor understanding are indirect benefits.

NFPA 13 (Standard for the Installation of Sprinkler Systems) specifies that quick-response and standard-response sprinklers shall not be mixed within the same compartment. This is to ensure uniformity in activation and discharge characteristics.

A (Compartment): Correct, all heads in a compartment must match type.

B, C, D: NFPA does not require wholesale replacement across zones, buildings, or corridors beyond the compartment.

NFPA uses mandatory language to indicate requirements:

“Shall” = mandatory requirement (must comply).

“Should” = advisory or recommended practice.

Therefore, when NFPA states “shall,” it represents a mandate.

D. mandate (Correct): Required compliance.

A. recommendation / B. guideline: NFPA uses “should” for recommendations.

C. performance standard: Not the intent of “shall” language.

The requirement for Spill Prevention, Control, and Countermeasure (SPCC) planning is specifically mandated under Federal Regulations 40 CFR Part 112, under the Clean Water Act (Oil Pollution Act amendments). Facilities with aboveground storage exceeding 1,320 gallons or underground storage over 42,000 gallons must develop and implement an SPCC plan to prevent oil discharges into navigable waters.

Correct Answer (A): Federal 40 CFR Part 112 establishes the threshold quantities and program requirements.

B (Joint Commission): TJC standards govern utility management but do not set SPCC requirements.

C (OSHA 1926.153): This regulation applies to liquefied petroleum gas safety, not petroleum or oil spill prevention.

D (NFPA 430): Governs oxidizers, not oil storage or spill prevention.

Before performing any work on electrical or mechanical equipment, OSHA and NFPA 70E require lockout/tagout (LOTO) procedures to isolate energy sources. This ensures the safety of workers and prevents accidental energization. Only after lockout/tagout can guards be removed, wiring disconnected, or diagnostic tests performed.

NFPA 110 (Standard for Emergency and Standby Power Systems) requires that emergency generators be tested monthly under load. If the available load is less than 30% of the generator’s nameplate rating, the test may be conducted until operating parameters (water temperature, oil pressure) stabilize. For longer durations, supplemental loading or load bank testing applies, but the minimum standard is monthly operation until systems stabilize.

NFPA 70 (NEC) Article 110.26(A)(1) establishes the depth of working space in front of electrical equipment. For systems 0–150 volts to ground, the minimum depth is 3 ft (36 in.); for 151–600 volts, the required depth is 3–4 ft depending on the condition (exposed live parts and grounded surfaces). In healthcare facilities, unless a more stringent “condition” applies, the baseline minimum clearance encountered for 600 V or less is 36 inches.

Hospital-grade receptacles, as defined in UL 498 and required under NFPA 99 Health Care Facilities Code, must be marked with a green dot. This identifies receptacles tested for durability, grounding reliability, and retention force.

Red outlets are often tied to emergency power, but that is separate from the “hospital grade” designation.

All construction and renovation projects in healthcare must include Infection Control Risk Assessment (ICRA). Infection Control professionals assess potential risks such as dust, ventilation disruptions, and waterborne hazards during construction. They ensure patient safety through control measures (barriers, negative pressure, monitoring).

D. Infection Control (Correct): Mandatory involvement in construction planning.

A. IT / B. Biomed / C. Patient Services: May participate but are not mandated by TJC and CDC requirements for ICRA.

NFPA 101 (Life Safety Code, Chapter 18/19.7.1.4) requires healthcare fire drills to include transmission of the fire alarm signal and a simulation of emergency fire conditions, ensuring staff are trained to carry out emergency duties. Full evacuation of patients is not required during drills.

In a fire tube boiler, hot gases of combustion pass through tubes, and water surrounds those tubes, absorbing the heat to create steam or hot water.

Correct: Fire tube (B) – Gases inside tubes, water outside.

Incorrect:

A. Water tube – The reverse: water flows inside the tubes, combustion gases surround them.

C. Vertical tube – Refers to orientation but still a water-tube or fire-tube design.

D. Cast iron sectional – Built from joined cast iron sections, not tubular gas-through-water design.

NFPA opening-protective tables specify that doors protecting openings in 2-hour fire-resistance-rated fire barriers are required to have a 1-1/2-hour (90-minute) fire protection rating. This distinction between the wall’s fire-resistance rating and the door’s fire-protection rating is standard in NFPA 101 and NFPA 80.

Federal and accreditor requirements establish two emergency exercises per year for hospitals: one full-scale community-based (or facility-based if community-based is not available) and a second exercise (which may be a second full-scale or an exercise such as a tabletop). Real events may be used to meet one of the required exercises when criteria are met.

According to NFPA 251 (Standard Methods of Tests of Fire Resistance of Building Construction and Materials), once a material or assembly is tested and a measure of time is obtained, that result is defined as the fire resistance rating. This rating expresses the duration that a building element can withstand a standardized fire exposure while maintaining structural integrity.

Correct Answer (B. fire resistance rating): NFPA 251 specifically defines this as the time result from fire exposure testing. It applies to walls, floors, and structural assemblies.

Incorrect Options:

A. flame spread rating: This measures only the surface burning characteristics of materials, determined using ASTM E84 or UL 723, not the endurance of an entire assembly.

C. fire assembly rating: This is not an officially recognized NFPA term; the proper terminology is fire resistance rating.

D. fire protection rating: This applies to opening protectives such as doors, windows, or shutters, which are tested using NFPA 252 or NFPA 257, not NFPA 251. Fire protection ratings are distinct from fire resistance ratings, since they do not measure full structural endurance.

Relevance to CHFM Compliance Domain:

The Certified Health Care Facility Manager (CHFM) exam includes compliance with fire and life safety codes under its “Compliance” content area. The CHFM Candidate Handbook emphasizes the requirement to understand and apply NFPA standards in healthcare facilities, ensuring compliance with regulatory fire safety measures such as those defined in NFPA 251.

A demand spike (kW) can occur when multiple large motors or systems restart simultaneously after a power interruption. Although energy consumption (kWh) over the interval may be less, the instantaneous demand registers higher because of inrush currents during restart. This aligns with CHFM exam energy management principles.