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

Written fire procedures must include the method for promptly notifying the fire department or emergency response agency, ensuring immediate response to protect life and property. Evacuation routes and equipment locations are important operational elements, but the mandatory code requirement is a defined notification procedure.

Best practice in safety and risk management is to have a final inspection performed by individuals with “fresh eyes” and go/no-go authority. Those directly involved may overlook issues due to task familiarity. Independent inspection reduces risk before re-energization.

The Joint Commission (TJC) requires hospitals to conduct environmental tours (also called Environment of Care rounds) with the primary purpose of identifying hazards to patients, staff, and visitors. While compliance, risk categorization, and system failures may be evaluated, the main focus is proactive hazard identification to reduce safety risks.

The primary cause of change orders is incomplete or unclear plans and specifications. Ensuring that drawings and specs are fully developed before bidding reduces ambiguity, scope gaps, and the likelihood of modifications during construction.

A (Correct): Complete plans/specs = fewer change orders.

B: Bonds/policies protect financially but do not reduce change orders.

C: Prequalification ensures capable bidders but doesn’t eliminate scope issues.

D: Competent managers/subcontractors help but cannot offset incomplete design docs.

Design–Bid–Build (DBB) is the traditional project delivery method where the architect/engineer completes design before contractors bid. The contractor has no input in the design phase.

IDP, DB, and CMAR all include contractor involvement earlier.

NFPA 101 (Life Safety Code, Section 9.6.1.6) requires that when a fire alarm system is out of service for more than 4 hours in a 24-hour period, the facility must (1) notify the authority having jurisdiction (AHJ) and (2) provide an approved fire watch until the system is restored. Internal notifications such as to administrators or vendors may occur, but the code specifically mandates AHJ notification and fire watch.

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.

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 a primary-secondary chilled water system, the primary loop is constant volume, supplying chilled water from the chiller plant. The secondary loop uses variable volume pumping to match distribution system load demand efficiently.

A. Secondary loop (Correct): Where variable flow is applied.

B. Open loop: Not a recognized term in this context.

C. Primary loop: Constant flow design.

D. Cooling tower loop: Separate condenser water system, not chilled water distribution.

The operations and maintenance (OandM) operating budget includes recurring expenses needed to run the facility: labor, staff training, utilities, and equipment/vehicle repairs. Capital improvements such as major building upgrades are typically not part of the operating budget; they belong in the capital budget.

Correct: Training (1), Utilities (3), and Vehicle repairs (4) are OandM operating costs.

Incorrect: Building improvements (2) are capital budget items.

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.

Leadership requires a business case to justify capital expenditures. The Return on Investment (ROI) demonstrates cost savings, efficiency, and risk reduction benefits of replacing the boiler, making it the most critical piece of information. Size, maintenance cost, or timeline support the request, but ROI is decisive for approval.

Building automation system (BAS) costs are based largely on the number of control points (sensors, outputs, and monitored parameters) that must be integrated. The cost is driven by how many signals must be tracked, rather than just the square footage or vendor.

A: Gross square footage can influence scope, but cost scales with monitored points.

B: Vendor may affect pricing, but primary cost driver is point count.

C: Technology choice matters, but the quantity of control points is more significant.

According to standard accounting practices, when an overhaul or replacement extends the useful life of an asset, it is considered a capital expenditure. Operating costs are day-to-day expenses; contingency is reserved budget for unforeseen costs; non-depreciable refers to land, not equipment.

NFPA 101 (Life Safety Code) requires that on-call sleep rooms provided in healthcare facilities must be protected by single-station smoke alarms or an automatic smoke detection system. This requirement ensures early warning for occupants who may be sleeping and unable to respond as quickly in an emergency.

B: Rated doors may be required in certain hazardous areas but are not the mandated feature for on-call sleep rooms.

C: Emergency call buttons are part of patient care areas, not sleep rooms.

D: Bathrooms are not required by Life Safety Code in on-call rooms.

To stay within the $5,000,000 annual budget, the facilities department must reduce monthly spending to $337,500 for the remaining 8 months.

Per the AIA General Conditions of the Contract for Construction (AIA Document A201), the architect reviews and approves shop drawings, product data, and samples for compliance with design intent and contract documents. The contractor ensures submission and coordination, but final approval authority rests with the architect.

When Alternate B is chosen, total price = Base Bid + price for Alternate B (or zero if “Included”).

A: Not available → cannot be selected.

B: $20,000 + Included ($0) = $20,000.

C: $19,000 + $500 = $19,500.

D: $19,000 + $1,000 = $20,000.

Lowest total = $19,500 (Company C).

The FGI Guidelines and ASHRAE healthcare design standards recommend steam humidifiers for duct-mounted systems in hospitals, since they minimize microbial growth. Reservoirs, spray, and pan humidifiers pose contamination risks and are not permitted for patient care areas.

Acceptable indoor CO₂ concentrations in healthcare facilities are generally expected to remain below 1,000 ppm, as recommended by ASHRAE Standard 62.1 (Ventilation for Acceptable Indoor Air Quality). A reading of 1,500 ppm typically signals inadequate ventilation and insufficient outside air being introduced into the space. This is a direct indicator of poor dilution of indoor contaminants.

Correct: Lack of outside air (C) – High CO₂ concentrations are directly linked to reduced outside air supply.

Incorrect:

A. Within design – Not correct, since 1,500 ppm exceeds design thresholds.

B. Vehicular exhaust – Would raise CO and NOx levels, not primarily CO₂.

D. Humidity/dewpoint – Unrelated to CO₂ measurement.

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.

The RCRA (1976) governs the proper management of hazardous waste from generation to disposal (“cradle to grave”). While healthcare organizations often think of sharps or medical waste, RCRA is broader, addressing hazardous chemicals, solvents, and pharmaceuticals. Medical waste is regulated under other federal and state rules.

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.

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 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.

The Safety and Security Management Plan under TJC’s Environment of Care standards requires healthcare facilities to regularly inspect buildings, facilities, and grounds to identify unsafe conditions and security risks.

C. Safety and Security Management (Correct): Includes hazard surveillance rounds.

A. Utilities Management: Focuses on utility systems operation and maintenance.

B. Hazardous Materials Management: Covers handling/storage/disposal of hazardous substances.

D. Fire Safety Management: Addresses fire protection systems and procedures, not general hazard inspection.

When fire protection systems (sprinklers, alarms) are impaired during construction, Interim Life Safety Measures (ILSM) must be implemented to maintain safety. These include fire watch, additional training, and temporary compensating measures.

B. ILSM (Correct): Required under TJC and NFPA 101 during impairments.

A. ICRA (Infection Control Risk Assessment): Applies to infection risk during construction, not fire protection.

C. PASS (Pull, Aim, Squeeze, Sweep): Fire extinguisher operation technique.

D. RACE (Rescue, Alarm, Contain, Extinguish): Emergency fire response procedure.

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 99, Health Care Facilities Code, sets the requirements for medical gas and vacuum systems, including design, installation, testing, and maintenance (in recent editions, see the chapter dedicated to Gas and Vacuum Systems). It also addresses source equipment, piping, alarms, and verification procedures used in patient care spaces.