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BOC Facility Principles UPDATED JUNE 2026 BOCATC.ORG/FACILITY BOC FACILITY PRINCIPLES BOCATC.ORG 2 Table of Contents INTRODUCTION3 PRELIMINARY QUESTIONS 4 16 ACCESSIBILITY5 PRIVACY AND CONFIDENTIALITY 6 SAFETY AND INFECTION CONTROL 8 Bloodborne Pathogens8 Strategies For Hazard Control9 Disposal of Potentially Hazardous/ Contaminated Materials 10 Hand Hygiene 11 Cleaning and Disinfecting11 Electrical Safety12 Patient Safety and Supervision13 Reporting Adverse Medical Events14 Storage and Handling 14 Emergency Preparedness15 Means of Egress and Exit Routes17 DISPLAY OF LICENSES, CERTIFICATIONS AND PROFESSIONAL STANDARDS18 APPENDIX I: REGULATORY BODIES BY PRACTICE SETTING 19 If you are seeking guidance in developing athletic training policies and procedures, please explore the BOC resource, Guiding Principles for AT Policy and Procedure Development. BOC FACILITY PRINCIPLES BOCATC.ORG 3 Providing athletic training services through a health care facility is complex and critical to providing optimal patient care. Some community partners (e.g., athletic directors, principals, superintendents, administrators, building engineers, etc.) may be unaware of the many federal, state and local regulations and standards that govern health care facilities. At the national level, no fewer than eight federal agencies and organizations have regulations that impact athletic training services. Local, state and national nongovernmental bodies issue rules, regulations and position statements that must be considered when reviewing and establishing policies for health care facilities. Local, state and federal entities issue regulations and standards – which often overlap – to ensure the quality of facilities where athletic training services are delivered. Failure to observe safety policies not only increases risk but also increases exposure to liability. Athletic Trainers (AT) may not be aware of all regulations and best practices that need to be followed; therefore, they are responsible for determining applicable regulations and best practices are necessary to ensure a safe and compliant health care facility. Individuals within an organization with specialized knowledge should review guidelines to ensure a thorough and complete assessment. Those who should be involved include but are not limited to: •Athletic Trainers •Physician(s) •Legal department (i.e. lawyers) •Risk management teams •Building supervisors •Human resources department personnel •Environmental services •Custodial/sanitation supervisors •Administration (e.g., athletic directors, principals/superintendents, presidents, etc.) This document was created to provide a framework for ATs to work with relevant community partners and their organizations to establish and assess policies, procedures, and operations that ensure the safe, effective, and compliant facilities in which to deliver athletic training services. This manual was created by a Facility Standards Work Group in 2012. A new Facility Principles Work Group updated the manual in 2026. Its members developed a comprehensive document detailing what is essential to ensure a safe, properly equipped health care facility. The work group included: •Dan Newman, MS, LAT, ATC (Work Group Co-Chair) •Jenna Wilkerson, MS, ATC (Work Group Co-Chair) •Amanda Beatty, MS, LAT, ATC •Darryl Conway, MA, AT, ATC •Kelly Corso, DAT, MS, LAT, ATC •Elizabeth Saunders Wegeler, DAT, LAT, ATC •Donita Valentine, DAT, ATC The following resources will help you gauge your health care facility’s compliance with applicable state, federal and oversight agency regulations, as well as best practices. Introduction BOC FACILITY PRINCIPLES BOCATC.ORG 4 Preliminary Questions RequirementYesNoComments, necessary actions and questions Is your program EXEMPT from state or federal OSHA regulations? Is your program EXEMPT from compliance with Title IX? Is your health care facility EXEMPT from federal ADA requirements? Do you have any other licensed health care providers besides the Athletic Trainer working in your organization? Do you have someone who is responsible for risk management for your organization? Are patient health records managed in paper or electronic format? Certain health care facilities delivering athletic training services may be exempt from some state and/or federal rules and regulations. ATs should be aware of any or all exemptions from state and/or federal rules and regulations prior to beginning an assessment. Before beginning your assessment, it is important to establish context for answering the questions in the document with your internal group of subject matter experts. BOC FACILITY PRINCIPLES BOCATC.ORG 5 Accessibility RequirementYesNoComments, necessary actions and questions Health care facilities are 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 •Accessible Parking is available Source References: The Americans with Disabilities Act | ADA.gov The Americans with Disability Act (ADA) of 1990 requires that buildings and rooms be accessible for those with disabilities. This can include disabled (temporary or permanent) patients, staff or visitors. Most buildings constructed in the past 35 years are ADA compliant or have been modified to become compliant. However, in areas where otherwise able-bodied people work and play, this may not always be the case. As has been stated previously, some organizations are exempt from federal regulations such as the ADA. Why is this important for health care facilities? Patients, staff or students using crutches or wheelchairs may require wider doorways, ramps, or other accommodations. Emergency response personnel may also need access, including elevators, to safely assist or transport individuals who are ill or injured. BOC FACILITY PRINCIPLES BOCATC.ORG 6 Privacy and Confidentiality The Health Insurance Portability and Accountability Act (HIPAA) provide the rules and regulations that establishes national standards to protect individuals’ medical records and other identifiable health information and applies to health plans, health care clearinghouses, and those health care providers that conduct health care transactions electronically. A full explanation of the HIPAA Privacy rule can be found here. This includes documentation, storage, dissemination and disposal of health records, as well as the use of electronic health or medical records (EHR/ EMR). Examples of sensitive information include but are not limited to the following: pre-participation evaluations, health records, physician visits/follow-ups, diagnostic reports, phone calls and text messages. The HIPAA Privacy Rule does not specify the length of medical record retention requirements. Rather, State laws generally govern how long medical records are to be retained. It is recommended that ATs familiarize themselves with the requirements of their state of employment. The HIPAA Security Rule requires that health care facilities implement policies and procedures to address the destruction and disposal of Protected Health Information (PHI) in any form. Failing to implement reasonable safeguards to protect PHI in connection with disposal could result in impermissible disclosures of PHI. The Family Educational Rights and Privacy Act (FERPA) provides protection of privacy for student educational records, which encompasses medical documentation and health records being included within the definition of educational records. The Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) strengthens HIPAA rules for privacy and security, especially for electronic health records. Examples of proper disposal methods may include, but are not limited to: •For PHI in paper records, shredding, burning, pulping, or pulverizing the records so that PHI is rendered essentially unreadable, indecipherable, and otherwise cannot be reconstructed. •For PHI on electronic media, clearing (using software or hardware products to overwrite media with non-sensitive data), purging (degaussing or exposing the media to a strong magnetic field in order to disrupt the recorded magnetic domains), or destroying the media (disintegration, pulverization, melting, incinerating, or shredding). BOC FACILITY PRINCIPLES BOCATC.ORG 7 Privacy and Confidentiality RequirementYesNoComments, necessary actions and questions Employee education about storage, handling and disposal of confidential patient information is available (i.e., FERPA and HIPAA) Communication to employees about storage, handling and disposal of confidential patient records occurs All interactions between patients and ATs or other health care providers are documented in the health records of each patient and securely maintained The facility has a locked file cabinet for all patient health files Electronic and paper copies of health information are protected and accessible/transferred only to authorized individuals. (i.e., FERPA, HIPAA and HITECH) There is a place to have private conversations with patients and/or parents/guardians Communication occurs with employees about their responsibility for ensuring the confidentiality of health care information Evidence of the above communication is documented Source References: HIPAA Home | HHS.gov Record Disposal FERPA | Protecting Student Privacy HITECH overview - HHS Why is this important for health care facilities? ATs must document patient care and ensure all records, including EHR/EMR, are securely stored and disposed of. Failure to protect confidential information can expose the facility to legal liability if data is compromised. BOC FACILITY PRINCIPLES BOCATC.ORG 8 Safety and Infection Control RequirementYesNoComments, necessary actions and questions Exposure Control Plan Create a written Exposure Control Plan in accordance with OSHA Standard 1910.1030(c) Ensure the Exposure Control plan is accessible to employees Review and update the Exposure Control plan at least annually to reflect new or revised procedures Gather and document input from non- managerial employees (e.g., health care providers responsible for direct patient care) when revising the Exposure Control Plan Employee Education Employers must offer bloodborne pathogens training at no cost to employees during work hours Training must be provided upon initial assignment to and renewed annually Training records must be documented in accordance with OSHA Standard 1910.1030(h)(2) Compliance Practice universal precautions when handling blood, body fluids, or other potentially infectious materials Source References: OSHA Occupational Safety and Health Standards, Standard # 1910.1030 NIOSH Bloodborne Infectious Disease: Risk Factors and Prevention Safety is all-encompassing and can include examining the policies and procedures of the program for the safety of patients and employees, as well as the safe operation of the health care facility. Why is this important for health care facilities? Employee education on potential job-related safety and health hazards protects the employees and patients. It is essential to identify the regulatory requirements with which the health care facility must comply, such as the Occupational Safety and Health Administration (OSHA) and applicable local health departments. Human resources staff members may be best to help answer these questions. Insurance, legal and risk management professionals can assist in identifying the regulations that apply to the athletic training program. BLOODBORNE PATHOGENS Employers are required to educate employees regarding safety and protection against accidental transmission of bloodborne pathogens. This education extends to those responsible for the daily maintenance and upkeep of the facility, such as housekeeping or custodial staff. The National Institute for Occupational Safety and Health (NIOSH) provides information on the prevention of occupational exposure to bloodborne pathogens. ATs should take into consideration laws, rules, regulations and/or guidance implemented due to local, state and/ or federal declared emergencies (e.g. state health departments, CDC/NIOSH, World Health Organization (WHO), etc.). BOC FACILITY PRINCIPLES BOCATC.ORG 9 Safety and Infection Control RequirementYesNoComments, necessary actions and questions Employers provide training to each employee regarding the use of PPE prior to working with hazardous materials Employers retrain employees on the use of PPE to reflect changes that impact the use of PPE (e.g., changes in the workplace, and changes in the types of PPE to be used) Employees are trained in the proper use of PPE, including: •When PPE is necessary •What PPE is necessary •Proper use, adjustment, and removal of PPE •Appropriate care, maintenance, and disposal of PPE PPE is available and readily accessible to all employees PPE is in conjunction with engineering controls and safe work practices to limit hazardous exposures Employee education regarding the use of PPE is sufficient and up to date with most recent OSHA standards Evidence of employee education is documented Source References: OSHA Recommended Practices for Safety and Health Programs, Hazard Prevention and Control NIOSH, About Hierarchy of Controls STRATEGIES FOR HAZARD CONTROL Controlling exposure to workplace hazards is essential for AT safety. The Hierarchy of Controls offers a framework for effectively reducing these exposures. This framework outlines five levels of action, ranked by overall effectiveness in reducing or eliminating hazards: 1.Elimination 2.Substitution 3.Engineering Controls 4.Administrative Controls 5.Personal Protective Equipment Personal protective equipment (PPE) is a defense mechanism for limiting exposure to hazardous materials. PPE should always be used alongside higher-level controls. To protect workers and patients, employers must provide appropriate PPE at no cost to employees. This PPE must be readily accessible and available in appropriate sizes. Employers are also responsible for assuring employee compliance with personal protective equipment laws. Examples of PPE specific to the athletic training field include but are not limited to: •Personal protective equipment for eyes, face, head and extremities (e.g., gloves, masks, eye protection) •Protective clothing •Respiratory devices •Protective shields and barriersNext >