The checklist provides detailed guidelines to identify environmental hazards and improve environmental safety.
There are 114 potential hazards that are rated across severity (i.e., negligible to catastrophic) and mishap
probability (i.e., likely to occur immediately to unlikely to occur). Each hazard is rated using a 5-point risk
assessment code (RAC) that combines the elements of hazard severity and mishap probability (i.e., negligible to
critical). For example, an RAC of 5 is a situation that requires immediate attention, such as an open window in
a patient’s room that is high above the ground. The MHECC is mandatory in all U.S.A. Veteran Affairs mental
health units responsible for treating persons known to be at risk for suicide. In terms of effectiveness and ease of
implementation, multidisciplinary safety inspection teams at 113 facilities implemented the checklist and identified
7,642 hazards with 5,834 (76.4%) of these hazards having been eliminated after one year of implementation (Mills
et al., 2010).