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

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.

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.

Overage = 140 cu. ft.

Each small cylinder = 25 cu. ft.

140 ÷ 25 = 5.6 → minimum 6 needed if rounding up. However, since the question asks for the minimum number to remove to get below the limit, removing 5 cylinders = 125 cu. ft. would still leave 15 cu. ft. over the limit. Therefore, 6 cylinders must be removed.

Correct answer = C (6), not B.

NFPA 25 (2011), Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, specifies that a fire pump flow test must be performed annually. This ensures that the pump delivers adequate flow and pressure under actual operating conditions. Weekly no-flow (churn) tests are also required, but full-flow condition testing is mandated at least once per year.

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.

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.

Cost reduction without reducing service scope can be achieved by:

Implementing an in-house first response program (1): Staff address minor issues before calling the vendor, reducing service calls.

Extending the contract length (4): Vendors often offer reduced rates for long-term contracts.

Increasing house calls (2): Increases cost, not savings.

Financing the contract (3): Impacts payment terms, not cost reduction.

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.

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

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.

According to NFPA 72: National Fire Alarm and Signaling Code, the following frequencies apply:

Waterflow devices (D): Must be tested quarterly.

Supervisory signal devices: Semiannual testing.

Duct detectors and door holders: Tested annually.

Thus, only water flow devices require quarterly testing.

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.

Hospitals must have a Type 1 Essential Electrical System (EES) as required by NFPA 99. Type 1 systems provide at least two separate branches: the Life Safety branch and the Critical branch, ensuring continuous power to essential life support, patient care, and safety functions during utility outages.

Type 2 systems (for smaller facilities) have fewer requirements.

Type A and B are not classifications under NFPA 99.

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.

Comprehensive and Detailed Explanation From Exact Extract:

Per NFPA 101: Life Safety Code, the maximum allowable capacity for soiled linen or trash receptacles located outside of hazardous storage rooms (such as within patient rooms or nurse stations) is 32 gallons (121 liters). If containers are larger than this, they must be stored in a room meeting hazardous area protection requirements.

Correct Answer (C. 32 gal.): Matches NFPA 101, 18/19.7.5.5.7 (Health Care Occupancies), which restricts container size to 32 gallons maximum unless in a protected hazardous storage room.

Incorrect Options:

A. 8 gal. and B. 16 gal. – These are not the standard NFPA thresholds.

D. 64 gal. – Exceeds NFPA’s maximum; would require special hazardous storage protections.

Relevance to CHFM: This falls under the Compliance domain, as CHFM professionals must ensure healthcare facilities follow NFPA 101 and Joint Commission standards regarding fire and life safety.

Budget forecasting based on partial-year actuals uses the annualization formula:

Annual Forecast

=

Actual Costs for Months

Number of Months

×

12

Annual Forecast=

Number of Months

Actual Costs for Months

​

×12

For 5 months of data, the multiplier is 12/5.

Correct (D): current 5-month actual × 12/5.

Incorrect:

(A) × 5/12 would shrink the budget, not project it.

(B) Uses only one month, not representative.

(C) Uses only 2 months, less reliable.

EPA and OSHA define regulated medical waste (RMW) as waste that is saturated or dripping with blood or other potentially infectious materials (OPIM).

B. Blood-saturated gauze (Correct): Meets the definition of RMW.

A. Fluorescent bulbs: Considered hazardous universal waste (mercury), not RMW.

C. Urine-soaked pads: Not classified as RMW unless visibly contaminated with blood.

D. Home-use sharps: Not regulated by EPA as medical waste from households.

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 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 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.

To evaluate overall building condition, the Facility Condition Index (FCI) is commonly used. FCI = Deferred Maintenance ÷ Current Replacement Value. A lower FCI indicates better building condition (less deferred maintenance relative to value).

Building 1: 1,200,000 ÷ 25,000,000 = 0.048

Building 2: 200,000 ÷ 2,500,000 = 0.080

Building 3: 25,000 ÷ 600,000 = 0.0417

Building 4: 900,000 ÷ 10,000,000 = 0.090

Building 3 has the lowest FCI (0.0417), which means it has the least deferred maintenance compared to its value and therefore is in the best overall condition.

Incorrect Options:

Building 1 (0.048) – Good, but not the lowest.

Building 2 (0.080) – Higher FCI means poorer condition.

Building 4 (0.090) – Highest FCI of the group.

“WAGD” stands for Waste Anesthetic Gas Disposal. These outlets are installed in operating rooms to remove excess anesthetic gases exhaled by patients or escaping from anesthesia equipment. The purpose is to maintain staff safety and compliance with NFPA 99 (Health Care Facilities Code), which requires WAGD systems in anesthetizing locations.

Correct (D): Operating rooms require WAGD outlets as part of medical gas and vacuum systems.

Incorrect:

A. boiler room: No patient care; WAGD outlets are not relevant.

B. electrical closet: For electrical equipment only, no medical gases.

C. laundry room: Handles linens, not anesthetic gas removal.

The CHFM exam Financial Management domain requires knowledge of cost savings and revenue generation calculations from operational changes such as recycling initiatives. In this example, gross revenue is calculated by summing the total recycling income streams (cardboard and aluminum).

Correct Answer (C. $7,200): Derived from combining $6,000 (cardboard) and $1,200 (aluminum) revenue.

Other options are incorrect because:

A ($6,000): Considers cardboard only.

B ($6,600): Misapplies aluminum tonnage conversion.

D ($18,000): Exaggerates revenue beyond calculated amounts.

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.

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.

The transformer voltage ratio is determined by the turns ratio:

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127

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127

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A. 110 (Correct): Secondary voltage is half of the primary because turns ratio = 0.5.

B. 127: Incorrect, not consistent with ratio.

C. 220: Would occur only if turns ratio = 1.

D. 440: Would occur if secondary had twice as many turns as primary.

Practical and ethical water conservation measures include landscape irrigation reduction (1) and metering cooling tower usage (3) since cooling towers are a major consumer of water.

2. Campaigns: Awareness is useful but not as effective as operational controls.

4. Reducing patient showers: Not appropriate for patient care and safety.

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.

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.