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Utility Management Plan Template
Use this utility management plan template to work through plan details and approval, purpose and objectives, scope and covered locations, utility systems inventory, risk and criticality assessment, and roles and responsibilities, giving each action an owner and a due date and tracking it to completion. Records support applicable accreditation and regulatory requirements, manufacturer recommendations and the organization's policies.
14 sections61 questions16 to 30 minutesFree
Utility Management PlanWard 3 · Risk and Criticality Assessment0 of 3 checked
- Record the method used to rate utility system criticality.
Photo Added - Record how recurring problems are identified and escalated.Photo Added
- Record who reviewed and approved this revision.Photo Added
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What’s in this checklist.
14 sections · 61 questions · 16 to 30 minutes · Free
- 5 questions
Record the organization and the facility or facilities this plan covers.
Enter textRecord the plan owner and the department responsible for the utility management program.
Enter textRecord the revision number and the committee or leader who approved this revision.
Enter textRecord the effective date of this revision.
MM/DD/YYYYRecord when the utility program is next due for review.
MM/DD/YYYY
- 3 questions
Record what the utility management program is intended to achieve, such as reliable utility operation, reduced utility-related risk and timely response to failures.
Enter textRecord the operations or patient care activities that depend on utility systems, where applicable.
Enter textRecord the objectives set for this plan period and who is accountable for each.
Enter text
- 3 questions
Record the buildings, sites and leased or off-site locations the plan covers.
Enter textRecord the departments and areas in scope, and any areas excluded with the reason.
Enter textRecord the critical areas where a utility failure would have the greatest impact, such as operating rooms, intensive care, laboratories or data rooms, where applicable.
Enter text
- 9 questions
Is electrical power and distribution in scope? If yes, record the main components and where they are located.
Add a noteIs emergency or backup power in scope, such as generators, transfer switches or UPS systems? If yes, record the equipment and the loads it supports.
Add a noteIs HVAC, including ventilation for critical areas, in scope? If yes, record the main systems and the areas they serve.
Add a noteAre plumbing, domestic water and drainage in scope? If yes, record the main systems and any water management arrangements.
Add a noteAre medical gas and vacuum systems in scope? If yes, record the sources, distribution and the areas served.
Add a noteAre steam, hot water or natural gas systems in scope? If yes, record the systems and the areas they serve.
Add a noteAre communication, nurse call or building automation systems in scope? If yes, record the systems and who owns each.
Add a noteAre elevators or other vertical transportation in scope? If yes, record the equipment and the areas served.
Add a noteRecord any other site-specific utility systems included in the plan.
Enter text
- 5 questions
For each utility system, record the areas affected and the likely consequence if it fails.
Enter textRecord the method used to rate utility system criticality.
Record the systems rated high risk or critical and the reason for each rating.
Enter textRecord dependencies between systems, such as HVAC or medical gas that depends on electrical power.
Enter textRecord the backup or alternate arrangements for each critical system, and any gaps.
Enter text
- 5 questions
Record the person accountable for the utility management program and their alternate.
Enter textRecord the facilities or engineering roles responsible for operating and maintaining each system.
Enter textRecord the responsibilities of department managers, such as reporting problems and taking part in failure response.
Enter textRecord the contractors and vendors responsible for each system and what their contracts cover.
Enter textRecord how utility issues are reported to leadership or safety committees, and how often.
Enter text
- 4 questions
Record how inspection, testing and maintenance activities are set for each system, such as manufacturer recommendations, risk assessment or applicable codes.
Enter textRecord where the maintenance schedule and intervals for each system are kept.
Enter textRecord who carries out each activity, in-house or contractor, and where the records are stored.
Enter textRecord how deficiencies found during maintenance or testing are logged, prioritized and followed up.
Enter text
- 6 questions
Record how a utility failure is identified and reported, and who receives the report.
Enter textFor each critical system, record where the failure response procedure is kept and who is responsible for it.
Enter textRecord the alternate or backup arrangements to be used during a failure, and how affected areas are supported.
Enter textRecord the escalation route and when the emergency operations plan is activated.
Enter textRecord how staff and affected departments are informed during a failure and when service is restored.
Enter textRecord how failures are reviewed afterwards and how lessons are fed back into this plan.
Enter text
- 4 questions
Record where shutdown controls and isolation points for each system are located.
Enter textAre shutdown controls and isolation points labeled? Record any that are not.
Add a noteRecord who is authorized to shut down or isolate each system, fully or partially.
Enter textUpload the utility maps, drawings or shutdown diagrams referenced by this plan.
Add Photo
- 4 questions
Record how utility incidents, failures and user complaints are logged.
Enter textRecord what is captured for each incident, such as the system, date, impact and immediate action taken.
Enter textRecord how root causes are investigated and corrective actions are tracked to closure, where applicable.
Enter textRecord how recurring problems are identified and escalated.
Enter text
- 3 questions
Record the indicators used to monitor utility performance, such as outages, planned maintenance completion or response times.
Enter textRecord who collects and reviews the data, and how often it is reported.
Enter textRecord the trends and improvement opportunities identified this period.
Enter text
- 4 questions
Record the staff who need training on utility systems and failure procedures.
Enter textRecord the system-specific training provided to maintenance staff and how competency is confirmed.
Enter textRecord the orientation given to contractors who work on utility systems.
Enter textRecord where training records are kept and when refresher training is due.
Enter text
- 3 questions
Record where maintenance, inspection and testing records are stored.
Enter textRecord where utility maps, drawings, equipment manuals and shutdown procedures are stored and who keeps them current.
Enter textRecord the retention period the organization has set for utility records.
Enter text
- 3 questions
Record the events that trigger a plan review, such as utility failures, new systems, construction, risk assessment changes or changes to regulatory or accreditation requirements.
Enter textRecord the changes made in this revision and the reason for each.
Enter textRecord who reviewed and approved this revision.
Enter text
How the Utility Management Plan template works.
Three steps, about 16 to 30 minutes.
Work through each section
Section by section, one check at a time.
Log every finding
Tap Fail, add a photo, assign who fixes it.
Sign off and share
The report is ready the moment you finish.
Same checklist, two ways to run it.
Paper for a one-off check. The app when every finding needs fixing.
Printed PDF
- Pen on paper
- Photos in your camera roll
- Report typed up later
InspectWrk appRecommended
- Photos on every finding
- Owner and due date per finding
- Report ready at sign-off
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What is a utility management plan template?
Quick answer
A utility management plan template helps a hospital, clinic or other facility write and maintain the plan for managing its utility systems. It records the systems covered, their risk and criticality, who is responsible, how they are maintained and tested, how failures are handled, where shutdown controls are, how incidents and performance are tracked, training, records and when the plan is reviewed. It records the organization's own arrangements and does not by itself meet any accreditation requirement.
A utility management plan, sometimes called a utility systems management plan, sets out how an organization keeps its utility systems reliable and what happens when one fails. This template gives facilities and engineering teams one structured place to write it: the plan owner and scope, an inventory of the systems in use, a risk and criticality rating for each, the people and contractors responsible, how inspection, testing and maintenance are organized, the planned response to a utility failure, shutdown and isolation information, incident follow-up, performance monitoring, training, records and plan review. Each system is marked as applicable or not, so the plan fits the facility instead of assuming every system exists.
The plan defines how the utility management program runs. It is not an inspection: utility rounds and inspection checklists record what was found on a given day, a utility outage response checklist documents the response to one event, and generator, transfer switch or medical gas test records hold the results of individual tests. The plan tells people where those records live and who owns them. In healthcare, accreditation bodies and regulators address utility systems in their own standards, and requirements differ by organization and country, so adapt the plan to the ones that apply to your facility.
Why do utility failures catch facilities teams unprepared?
A chiller trips on a hot afternoon. The engineer on shift knows where the isolation valve is, but the backup arrangement for the operating rooms was agreed by someone who left two years ago, and nobody can find the drawing.
When the plan is a document written once for a survey, it stops matching the building. The systems change, the contractors change, and the plan quietly goes out of date until the day it is needed.
Before and After InspectWrk
Before InspectWrk
- The plan is a document written once and filed until the next survey.
- Nobody is sure which systems are critical or who owns each one.
- Utility drawings and shutdown locations live in one engineer's head.
After InspectWrk
- The current plan is available on any device, with owners and review dates for every section.
- Each system has a criticality rating, a responsible person and its backup arrangement recorded.
- Failures and incidents feed straight into the next plan review.
Why is a utility management plan template important?
Utility failures in a hospital are rarely a surprise to the systems, only to the people. A written plan helps you:
- Know what you run: every utility system in scope is listed, with the areas it serves.
- Rank the risk: critical systems and their dependencies are identified before something fails.
- Assign ownership: each system has a responsible person or contractor and an alternate.
- Keep it current: review triggers and revision history show the plan changes when the facility does.
What should be included in a utility management plan template?
A complete plan covers three areas:
Plan and systems
- Plan owner, version, approval, effective date and next review
- Purpose, objectives, buildings and areas in scope, and critical areas
- Inventory of the utility systems that apply to the facility
- Risk and criticality rating, dependencies and backup arrangements for each system
People and procedures
- Program owner, facilities roles, department managers and contractors
- How inspection, testing and maintenance are set, carried out and recorded
- Planned failure response, escalation and communication
- Shutdown controls, isolation points, labeling and utility drawings
Monitoring and upkeep
- Incident and problem logging with corrective action follow-up
- Performance indicators, reporting and trends
- Training, competency and contractor orientation
- Record locations, review triggers and revision history
How do teams use a utility management plan template?
Build the plan in this order:
- Record the plan owner, version, approval, purpose and the locations the plan covers.
- Mark which utility systems apply and rate the risk and criticality of each.
- Assign responsibilities and record how each system is maintained, tested and recorded.
- Write down the failure response, escalation and shutdown information for critical systems.
- Set performance indicators, training and review triggers, then review the plan after failures and changes.
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See which checklists your team has in progress across every site, jump into the same inspection with one tap, and keep field, supervisor, and back-office views in sync without sending screenshots on WhatsApp.
- Organise inspection data by site, team, and date
- Assign checks to the inspector or vendor responsible
- Track completion across every location in one view
- Keep field and back-office in sync in real time
- Comment on findings without leaving the inspection
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Every team reports differently. Build the report your operations, quality, or compliance leads actually want to read, share it as a branded PDF, and schedule delivery to the stakeholders who need it.
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- Share to email, Drive, Teams, or Slack in one click
- Filter findings by site, severity, or corrective-action status
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- Explore checklist data with charts and breakdowns that stay tied to the underlying inspections, without exporting to spreadsheets.
Utility Management Planquestions
See this checklist running on your own sites in a 30-minute demo.
Book a Free DemoIt is a structured document for writing and maintaining the plan an organization uses to manage its utility systems. It covers the plan owner and scope, an inventory of the utility systems in use, a risk and criticality rating for each, roles and contractor responsibilities, how inspection, testing and maintenance are organized, the planned response to utility failures, shutdown and isolation information, incident follow-up, performance monitoring, training, records and the review process. It is used most often by hospitals and other healthcare facilities, but any facility with critical utility systems can use it.
A utility inspection checklist records whether a system was checked on a given day and what was found. The plan sits above that. It defines which systems are covered, how critical each one is, who is responsible, how often activities are set and where the inspection, testing and maintenance records are kept. Most facilities need both. The plan organizes the program, and the inspection and testing checklists produce the day-to-day records the plan points to, which is what makes the plan something you can actually show is working.
No. An outage response checklist is used during and after one specific outage to document what happened and what was done, from confirming the outage to restoring service. The plan is written in advance. It records the failure response procedures for each critical system, who is responsible for them, the backup arrangements and how failures are reviewed afterwards. When an outage happens, the response checklist records the event, and the lessons from it feed back into the next review of the plan so the same failure is handled better next time.
Only the ones your facility actually has. Common systems include electrical distribution, emergency and backup power, HVAC and critical area ventilation, plumbing and domestic water, medical gas and vacuum, steam, hot water and natural gas, communication and nurse call systems, building automation and elevators. The template marks each system as applicable or not, so a clinic without medical gas or a building without steam is not forced to fill in sections that do not apply. Add any site-specific systems at the end, and rate each included system for risk and criticality.
Not on its own. The template helps you organize your utility systems management program and record your own arrangements. Accreditation bodies and regulators set their own requirements for utility systems in healthcare, and those requirements differ by organization, facility type and country. Check the current standards that apply to your facility, adapt the plan to them, and keep the maintenance, testing and incident records the plan refers to, because surveyors usually look for evidence that the plan is being followed, not just that it exists on paper.
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