The rapid pace of change in healthcare has caused critical engineering systems in hospitals and other healthcare facilities systems to be altered and upgraded on a virtually continuous basis. Changes to these systems, which include heating, ventilating, and air conditioning (HVAC), medical gases, normal and emergency electrical systems, plumbing, and fire protection systems, often are not properly documented. As a result, healthcare facilities may, over time, be exposed to increased risk. Such a situation compromises an organization's high level of patient and staff safety; it also may cause problems during a Joint Commission on Accreditation of Healthcare Organizations review of environment of care. This article outlines seven specific questions safety officers should review to determine if their facility needs a thorough systems assessment.