Allied

1. JCI KPIS

   1. Biomedical Preventive Maintenance Completion rate 

   2. Critical Equipment down time(in hrs)

2. Documents Required 

AOP

1. GLUCOMETER DAILY QC CHECKLIST

2. RADIOLOGY IMAGE QUALITY

3. RADIOLOGY PEER REVIEW FORM

4. RADIOLOGY PPE CHECKLIST

5. RADIOLOGY QUALITY CONTROL PROGRAM DAILY SURVEILLANCE OF IMAGING RESULTS

ASC

1. ATTENDANCE SHEET FOR COMPANY REPRESENTATIVES_IMPLANTS[1]

2. IMPLANT TRACKING REGISTER.DOCX

COP

1. CRASH CART DAILY CHECKLIST

2. LASER SAFETY CHECKLIST

3. CLINICAL ALARMS RESPONSE EVALUATION

CLINICAL ALARM RISK ASSESSMENT

1. ALARM RISK ASSESSMENT FLOOR

2. ALARM RISK ASSESSMENT LDR

3. ALARM RISK ASSESSMENT OB CLINIC

4. ALARM RISK ASSESSMENT ORTHO OPD

5. ED ALARM RISK ASSESSMENT

6. ICU ALARM RISK ASSESSMENT

7. NICU ALARM RISK

MMU

1. CRASH CART DAILY MONTHLY CHECKLIST

2. REFRIGERATOR TEMP LOG

FMS

1. DG LOAD TEST REPORT 

2. DIFFERENTIAL AIR PRESSURE MONITORING CHECKLIST

3. EMERGENCY DG RESPONSE TEST REPORT 

4. LIFT MONTHLY INSPECTION AND TEST FORM 

5. MAINTENANCE LOG 

6. MECHANICAL ROOMS CHECKLIST 

7. MEDICAL GAS MONITORING SHEET

8. NEGATIVE PRESSURE MONITORING - BY ENGINEERING TEAM

9. TEMPERATURE AND HUMIDITY RECORD

10. UTILITY EQUIPMENT INVENTORY

11. WHEELCHAIRS SAFETY CHECKLIST

12. EQUIPMENT INVENTORY 

FMS PROGRAM RISK ASSESSMENT

1. MEDICAL EQUIPMENT RA

2. UTILITY SYSTEM RA

HCT

1. DRILL SCENARIO 

2. DRILL EVALUATION 

3. NEW SOFTWARE ASSESEMENT CHECKLIST 

4. IT NEW TECHNOLOGY EVALUATION 

IT DOWNTIME 

1.PLANNED DRILL

1. IT DOWNTIME DRILL OBSERVATION OPD PLANNED

2. IT DOWNTIME PLANNED 

2.UNPLANNED DRILL

1. IT DOWNTIME DRILL EVALUATION FORM.

2. IT DOWNTIME UNPLANNED SCENERIO

PCI

1. PORTABLE SUCTION CHECKLIST

2. TEMPERATURE AND HUMIDITY RECORD

INFECTION CONTROL AUDIT CHECKLIST

1. CSSD INFECTION CONTROL CHECKLIST

2. LABORATORY INFECTION CONTROL CHECKLIST

3. OPERATING ROOM

4. RADIOLOGY INFECTION CONTROL CHECKLIST

QPS

1. INCIDENT REPORTING FORM 

2. RISK ASSESSMENT TEMPLATE

3. RCA FRAME WORK 

4. RCA_FRAMEWORK  JCI

SQE

1. DEPARTMENT ORIENTATION CHECKLIST

2. EMPLOYEE TRAINING CHECKLIST

3. TRAINING ATTENDANCE

4. STAFFING PLAN TEMPLATE

1. JCI KPIs

   1. Percentage of transfusion reactions

   2. TAT for issue of Blood and Blood Components

   3. Waste of blood and blood components(Among Those issued)

   4. Waste of blood and blood components (At blood bank / Blood storage areas.

   5. CT Ratio (cross match to transfusion )

   6. Blood availability rate 

2. Documents Required

AOP

1. REQUEST FOR BLOOD

COP

1. BLOOD PRODUCTS TRANSFUSION MONITORING FORM

2. BLOOD TRANSFUSION REACTION FORM

3. BLOOD TRANSFUSION RECORD FORM

IPSG

1. CRIICAL VALUE, TELEPHONE, VERBAL ORDER RECEIVING FORM

2. CRTICAL VALUE REGISTER TEMPLATE

PCC

1. BLOOD TRANSFUSION CONSENT

FMS

1. BLOOD SPILL KIT 

2. MEDICAL WASTE COLLECTION RECORDS

3. TEMPERATURE AND HUMIDITY RECORD

MOI

1. MEDICAL RECORD REVIEW TOOL

PCI

1. BLOOD BODY FLUID EXPOSURE FORM

2. BLOOD SPILL DRILL EVALN

3. BLOOD SPILL KIT

4. HAND HYGIENE COMPETENCY

5. HAND HYGIENE OBSERVATION TOOL

6. HEPATITIS B VACCINATION RECORD

7. NEEDLE STICK RECORD

8. TEMPERATURE AND HUMIDITY RECORD

9. WASTE DISPOSAL AUDIT TOOL

INFECTION CONTROL AUDIT CHECKLIST

1. LABORATORY INFECTION CONTROL CHECKLIST

QPS

1. INCIDENT REPORTING FORM 

2. ACTION PLAN FORM

3. RCA_FRAMEWORK  JCI

4. RCA FRAME WORK 

5. RISK ASSESSMENT TEMPLATE

SQE

1. DEPARTMENT ORIENTATION CHECKLIST

2. EMPLOYEE TRAINING CHECKLIST

3. TRAINING ATTENDANCE

4. STAFF FILE COMPLETION CHECKLIST.

5. PROFESSIONAL WISE SQE REQUIREMENTS

1. JCI KPIs

   1. High Alert Medications including LASA storage compliance Rate 

   2. Medication error rate in IPD

   3. Incidence of medication errors (Prescription)  (IPD)

   4. Incidence of medication errors (Adminstering)  (IPD)

   5. Incidence of medication errors (Dispensing)  (IPD)

2. Document Required for JCI

   1. ADR MONITORING

   2. ADVERSE REACTION REPORTING FORM

   3. CONTRAST MEDIA ORDER

   4. CRASH CART DAILY MONTHLY CHECKLIST

   5. DECLARATION OF NEAR EXPIRY, RECALLED OR DAMAGED MEDICATIONS

   6. DRUG DELETION FORM

   7. DRUG RECALL FORM

   8. EVALUATION OF MEDICATION SUPPLIER COMPANY FORM

   9. FLOOR STOCK DAILY MEDICATION CHECKLIST

   10. FORMULARY APPLICATION SUBMISSION FORM

   11. MED STORAGE AREA AUDIT TOOL

   12. MEDICATION ERROR FORM

   13. MEDICATION ERROR MONITORING

   14. MEDICATION PRESCRIPTON AND ADMINISTRATION RECORD

   15. MEDICATION RECONCILIATION FORM

   16. NEWLY ADDED DRUG EVALUATION FORM

   17. NON-FORMULARY DRUG REQUEST FORM

   18. PATIENT OWN MEDICATION

   19. PHARMACY INTERVENTION REPORT

   20. PRESCRIPTION AUDIT FORM

   21. REFRIGERATOR TEMP LOG

   22. RESTRICTED ANTIMICROBIAL USE JUSTIFICATION FORM

1. JCI KPIs

   1. CSSD Biological indicator Compliance Rate

   2. Sterilizer Load Control Compliance Rate

   3. Leak test  Compliance Rate

2. Documents Required

ASC

1. ATTENDANCE SHEET FOR COMPANY REPRESENTATIVES_IMPLANTS[1]

2. IMPLANT TRACKING REGISTER.DOCX

3. OPERATION SUMMARY

4. POST SURGICAL CARE PLAN - FORM

5. PRE-OPERATIVE CHECK LIST

COP

1. CRASH CART DAILY CHECKLIST

2. LASER SAFETY CHECKLIST

3. CODE BLUE DRILL EVALUATION FORM

IPSG

1. ALTRENATE SITE MARKING - BODY DIAGRAM

2. SURGICAL SAFETY CHECKLIST

3. TIME OUT FORM-OUTSIDE OT

MMU

1. CRASH CART DAILY MONTHLY CHECKLIST

2. FLOOR STOCK DAILY MEDICATION CHECKLIST

3. MED STORAGE AREA AUDIT TOOL

4. REFRIGERATOR TEMP LOG

FMS

1. TEMPERATURE AND HUMIDITY RECORD

2. DIFFERENTIAL AIR PRESSURE MONITORING CHECKLIST 

3. NEGATIVE PRESSURE MONITORING - BY ENGINEERING TEAM

4. MEDICAL GAS MONITORING SHEET 

5. EQUIPMENT INVENTORY 

6. UTILITY EQUIPMENT INVENTORY

7. MAINTENANCE LOG 

8. FACILITY ROUNDS CHECKLIST - TEMPLATE 

9. CHEMICAL SPILL KIT CHECKLIST 

10. HAZMAT INVENTORY 

11. BLOOD SPILL KIT 

12. HAZARDOUS WASTE MATERIAL INVENTORY 

13. MEDICAL WASTE COLLECTION RECORDS

14. MONTHLY HAZMAT CHECKLIST

15. MSDS LABEL 

16. FIRE DOOR INSPECTION QUARTERLY CHECKLIST 

17. FIRE EXTINGUISHER INSPECTION CHECKLIST 

18. FIRE SPRINKLER INSPECTION CHECKLIST

19. CHECKING FIRE HOSE REELS 

20. CHECKING FIRE HYDRANT SYSTEM  

21. EMERGENCY FIRE EXIT LED LIGHT CHECKLIST 

22. SMOKE DETECTOR CHECKLIST

23. UTILITY SERVICE ROOMS MONTHLY SAFETY INSPECTION CHECKLIST

24. TEMPLATE CODE DRILL EVALUATION REPORT

FMS PROGRAM RISK ASSESSMENT

1. SAFETY MANAGEMENT RA

2. HAZMAT MANAGEMENT

3. MEDICAL EQUIPMENT RA

DRILL EVALUATION FORMS 

1. HAZMAT SPILLAGE EVALUATION FORM

EMERGENCY CODE SCENERIO

1. CODE BROWN HAZMAT SPILL SCENERIO

MOI

1. DOCUMENT REQEST FORM

MEDICAL RECORD AUDIT 

1. MEDICAL RECORD REVIEW TOOL

PCI

1. HAND HYGIENE COMPETENCY

2. HAND HYGIENE OBSERVATION TOOL

3. BLOOD BODY FLUID EXPOSURE FORM

4. BLOOD SPILL DRILL EVALN

5. BLOOD SPILL KIT

6. INFECTION CONTROL PROGRAM STAFFING PLAN UPDATED

7. NEEDLE STICK RECORD

8. TEMPERATURE AND HUMIDITY RECORD

9. TRAINING ATTENDANCE

10. ICRA CHECKLIST AND PERMIT CONSTRUCTION; RENOVATION; DEMOLITION

11. SSI BUNDLE AUDIT TOOL

 HK CLEANING CHECKLIST

1. GENERAL CSSD CLEANING CHECKLIST

2. GENERAL DAILY HOUSEKEEPING CLEANING CHECKLIST

3. TERMINAL ROOM CLEANING CHECKLIST

INFECTION CONTROL AUDIT CHECKLIST

1. CSSD INFECTION CONTROL CHECKLIST

2. CENTRAL SUPPLY SERVICES

3. ENVIRONMENTAL IC AUDIT CHECKLIST

4. HOUSEKEEPING INFECTION CONTROL CHECKLIST

BUNDLE CHECKLISTS

1. CENTRAL LINE HANDLING AND DRESSING CHECKLIST

2. SURGICAL SITE INFECTION PREVENTION BUNDLE

EVENT FORM 

1. SSI EVENT FORM

QPS

1. 1. RCA_FRAMEWORK  JCI

   2. INCIDENT REPORTING FORM 

   3. ACTION PLAN FORM

   4. RISK ASSESSMENT TEMPLATE

   5. MINUTES OF MEETING 

   6. RCA FRAME WORK 

SQE

1. DEPARTMENT ORIENTATION CHECKLIST

2. EMPLOYEE TRAINING CHECKLIST

3. TRAINING ATTENDANCE

4. STAFF FILE COMPLETION CHECKLIST.

5. NURSING STAFF CLINICAL PRACTICE EVALUATION

6. INITIAL EVALUATION FORM

7. ANNUAL STAFF PERFORMANCE APPRAISAL FORM

8. STAFFING PLAN TEMPLATE

1. JCI KPIs

   1. Wrong Inpatient Meal Delivery Rate 

1. JCI KPIs

   1. Fire Safety Training Compliance Rate

   2. Utility Service PPM compliance Rate

   3. Construction renovation safety inspection compliance rate

2. Document Required

MMU

1. CRASH CART DAILY MONTHLY CHECKLIST

2. REFRIGERATOR TEMP LOG

FMS

1. ATTENDANCE GRID - FMS TRAINING 

2. BLOOD SPILL KIT 

3. CHECKING EMERGENCY LIGHTS 

4. CHECKING FIRE HOSE REELS 

5. CHECKING FIRE HYDRANT SYSTEM  

6. CHECKING LADDERS 

7. CHEMICAL SPILL KIT CHECKLIST

8. DG LOAD TEST REPORT 

9. DIFFERENTIAL AIR PRESSURE MONITORING CHECKLIST 

10. EMERGENCY DG RESPONSE TEST REPORT 

11. EMERGENCY EYEWASH AND SHOWER WEEKLY INSPECTION CHECKLIST 

12. EMERGENCY FIRE EXIT LED LIGHT CHECKLIST 

13. EQUIPMENT INVENTORY 

14. FACILITY ROUNDS CHECKLIST - TEMPLATE 

15. FIRE DOOR INSPECTION QUARTERLY CHECKLIST 

16. FIRE EXTINGUISHER INSPECTION CHECKLIST 

17. FIRE SPRINKLER INSPECTION CHECKLIST 

18. FMS ATTENDANCE

19. FMS BUDGET 

20. FMS TRAINING CALENDAR 

21. HAZARDOUS WASTE MATERIAL INVENTORY 

22. HAZMAT INVENTORY 

23. HVA - SAMPLE 

24. JCIA FACILITY TOUR MAP FOR COMPLETION

25. LIFT MONTHLY INSPECTION AND TEST FORM 

26. MAINTENANCE LOG 

27. MECHANICAL ROOMS CHECKLIST 

28. MEDICAL GAS MONITORING SHEET 

29. MEDICAL WASTE COLLECTION RECORDS

30. MONTHLY HAZMAT CHECKLIST

31. MSDS LABEL 

32. NEGATIVE PRESSURE MONITORING - BY ENGINEERING TEAM

33. PORTABLE EYE WASH INSPECTION CHECKLIST

34. PRE ON GOING POST CONSTRUCTION CHECKLIST

35. RISK REGISTER (MODEL)  

36. ROOF TOP INSPECTION FORM

37. SECURITY CHECKLIST

38. SMOKE DETECTOR CHECKLIST

39. STAIR CASE INSPECTION FORM

40. STRUCTURAL, NON STRUCTURAL  INTEGRITY

41. SUB-CONTRACTORS SITE INDUCTION SHEET

42. TEMPERATURE AND HUMIDITY RECORD

43. TEMPLATE CODE DRILL EVALUATION REPORT

44. UTILITY EQUIPMENT INVENTORY

45. UTILITY SERVICE ROOMS MONTHLY SAFETY INSPECTION CHECKLIST

46. WATER TANKER RESPONSE REPORT

47. WHEELCHAIRS SAFETY CHECKLIST

DRILL EVALUATION FORMS 

1. CODE BLACK - BOMB THREAT

2. CODE RED, GREEN DRILL EVALUATION

3. CODE RED,EVALUATION MODIFIED

4. CODE BLUE, DRILL EVALUATION LATEST

5. CODE PINK PATIENT MISSING EVALUATION FORM

6. VIOLENT PERSON DRILL OBSERVATION

7. IT DOWNTIME DRILL OBSERVATION

8. EXTERNAL DISASTER DRILL EVALUATION FORM

9. HAZMAT SPILLAGE EVALUATION FORM

FMS RISK ASSESSMENT 

1. HOSPITAL-WIDE RISK ASSESSMENT PRIORITIES 

FMS PROGRAM RISK ASSESSMENT

1. FIRE SAFETY MANAGEMENT

2. RISK ASSESSMENT - FIRE SAFETY - REVIEWED

3. SECURITY MANAGEMENT RA

4. HAZMAT MANAGEMENT

5. MEDICAL EQUIPMENT RA

6. UTILITY SYSTEM RA

7. SAFETY MANAGEMENT RA

8. CONSTRUCTION MANAGEMENT

9. DISASTER MANAGEMENT

EMERGENCY CODE SCENERIO

1. 1. 1. CODE GREY - TRACKCARE DOWNTIME SIMULATION

      2. CODE WHITE (VIOLENT PATIENTVISITOR) SCENARIO

      3. CODE RED SCENARIO

      4. CODE BROWN HAZMAT SPILL SCENERIO

      5. CODE AMBER CHILD ABDUCTION SCENARIO

      6. CODE GREEN MASS EVACUATION SCENARIO

WORKPLACE VIOLENCE

1. OSHA_WORKPLACE VIOLENCE WORKSITE AUDIT CHECKLISTS

2. WORK SITE ANALYSIS CDC CHECKLIST-3

3. OSHA_WORKPLACE VIOLENCE PROGRAM CHECKLISTS

4. WORK SITE ANALYSIS CDC CHECKLIST-2

HCT

1. DRILL SCENARIO 

2. DRILL EVALUATION 

3. NEW SOFTWARE ASSESEMENT CHECKLIST 

4. IT NEW TECHNOLOGY EVALUATION 

IT DOWNTIME 

1.PLANNED DRILL

1. IT DOWNTIME DRILL OBSERVATION OPD PLANNED

2. IT DOWNTIME PLANNED 

2.UNPLANNED DRILL

1. IT DOWNTIME DRILL EVALUATION FORM.

2. IT DOWNTIME UNPLANNED SCENERIO

PCI

1. BLOOD SPILL KIT

2. ICRA CHECKLIST AND PERMIT CONSTRUCTION; RENOVATION; DEMOLITION

3. TEMPERATURE AND HUMIDITY RECORD

4. WASTE DISPOSAL AUDIT TOOL

INFECTION CONTROL AUDIT CHECKLIST

1. ENVIRONMENTAL IC AUDIT CHECKLIST

SQE

1. DEPARTMENT ORIENTATION CHECKLIST

2. EMPLOYEE TRAINING CHECKLIST

3. STAFF FILE COMPLETION CHECKLIST.

4. STAFFING PLAN TEMPLATE

5. TRAINING ATTENDANCE

HR FILE - CATEGORY WISE REQUIREMENTS

1. HR FILE DOCUMENTS LIST

2. PROFESSIONAL WISE SQE REQUIREMENTS

3. SQE STAFF FILE LIST CATEGORY WISE

1. JCI KPIs

   1. Facility Safety & Security inspection compliance rate

   2. Hazmat segregation, storage, Labeling Compliance Rate

   3. Medical Waste Collection Rate

   4. Pest Control Schedule compliance rate

   5. Housekeeping task completion rate

   6. Housekeeping staff absenteeism  Rate

2. Document Required

COP

1. CLINICAL ALARMS RESPONSE EVALUATION

2. LASER SAFETY CHECKLIST

3. CRASH CART DAILY CHECKLIST

FMS

1. ATTENDANCE GRID - FMS TRAINING 

2. BLOOD SPILL KIT 

3. CHECKING EMERGENCY LIGHTS 

4. CHECKING FIRE HOSE REELS 

5. CHECKING FIRE HYDRANT SYSTEM  

6. CHECKING LADDERS 

7. CHEMICAL SPILL KIT CHECKLIST 

8. DG LOAD TEST REPORT 

9. DIFFERENTIAL AIR PRESSURE MONITORING CHECKLIST 

10. EMERGENCY DG RESPONSE TEST REPORT 

11. EMERGENCY EYEWASH AND SHOWER WEEKLY INSPECTION CHECKLIST 

12. EMERGENCY FIRE EXIT LED LIGHT CHECKLIST 

13. EQUIPMENT INVENTORY 

14. FACILITY ROUNDS CHECKLIST - TEMPLATE 

15. FIRE DOOR INSPECTION QUARTERLY CHECKLIST 

16. FIRE EXTINGUISHER INSPECTION CHECKLIST 

17. FIRE SPRINKLER INSPECTION CHECKLIST 

18. FMS ATTENDANCE

19. FMS BUDGET 

20. FMS TRAINING CALENDAR 

21. HAZARDOUS WASTE MATERIAL INVENTORY 

22. HAZMAT INVENTORY 

23. HVA - SAMPLE 

24. JCIA FACILITY TOUR MAP FOR COMPLETION

25. LIFT MONTHLY INSPECTION AND TEST FORM 

26. MAINTENANCE LOG 

27. MECHANICAL ROOMS CHECKLIST 

28. MEDICAL GAS MONITORING SHEET 

29. MEDICAL WASTE COLLECTION RECORDS

30. MONTHLY HAZMAT CHECKLIST

31. MSDS LABEL 

32. NEGATIVE PRESSURE MONITORING - BY ENGINEERING TEAM

33. PORTABLE EYE WASH INSPECTION CHECKLIST

34. PRE ON GOING POST CONSTRUCTION CHECKLIST

35. RISK REGISTER (MODEL)  

36. ROOF TOP INSPECTION FORM

37. SECURITY CHECKLIST

38. SMOKE DETECTOR CHECKLIST

39. STAIR CASE INSPECTION FORM

40. STRUCTURAL, NON STRUCTURAL  INTEGRITY

41. SUB-CONTRACTORS SITE INDUCTION SHEET

42. TEMPERATURE AND HUMIDITY RECORD

43. TEMPLATE CODE DRILL EVALUATION REPORT

44. UTILITY EQUIPMENT INVENTORY

45. UTILITY SERVICE ROOMS MONTHLY SAFETY INSPECTION CHECKLIST

46. WATER TANKER RESPONSE REPORT

47. WHEELCHAIRS SAFETY CHECKLIST

DRILL EVALUATION FORMS 

1. CODE BLACK - BOMB THREAT

2. CODE RED, GREEN DRILL EVALUATION

3. CODE RED,EVALUATION MODIFIED

4. CODE BLUE, DRILL EVALUATION LATEST

5. CODE PINK PATIENT MISSING EVALUATION FORM

6. VIOLENT PERSON DRILL OBSERVATION

7. IT DOWNTIME DRILL OBSERVATION

8. EXTERNAL DISASTER DRILL EVALUATION FORM

9. HAZMAT SPILLAGE EVALUATION FORM

FMS RISK ASSESSMENT 

1. HOSPITAL-WIDE RISK ASSESSMENT PRIORITIES 

FMS PROGRAM RISK ASSESSMENT

1. FIRE SAFETY MANAGEMENT

2. RISK ASSESSMENT - FIRE SAFETY - REVIEWED

3. SECURITY MANAGEMENT RA

4. HAZMAT MANAGEMENT

5. MEDICAL EQUIPMENT RA

6. UTILITY SYSTEM RA

7. SAFETY MANAGEMENT RA

8. CONSTRUCTION MANAGEMENT

9. DISASTER MANAGEMENT

EMERGENCY CODE SCENERIO

1. CODE GREY - TRACKCARE DOWNTIME SIMULATION

2. CODE WHITE (VIOLENT PATIENTVISITOR) SCENARIO

3. CODE RED SCENARIO

4. CODE BROWN HAZMAT SPILL SCENERIO

5. CODE AMBER CHILD ABDUCTION SCENARIO

6. CODE GREEN MASS EVACUATION SCENARIO

WORKPLACE VIOLENCE

1. OSHA_WORKPLACE VIOLENCE WORKSITE AUDIT CHECKLISTS

2. WORK SITE ANALYSIS CDC CHECKLIST-3

3. OSHA_WORKPLACE VIOLENCE PROGRAM CHECKLISTS

4. WORK SITE ANALYSIS CDC CHECKLIST-2

HCT

1. DRILL SCENARIO 

2. DRILL EVALUATION 

3. NEW SOFTWARE ASSESEMENT CHECKLIST 

4. IT NEW TECHNOLOGY EVALUATION

IT DOWNTIME 

1.PLANNED DRILL

1. IT DOWNTIME DRILL OBSERVATION OPD PLANNED

2. IT DOWNTIME PLANNED 

2.UNPLANNED DRILL

1. IT DOWNTIME DRILL EVALUATION FORM.

2. IT DOWNTIME UNPLANNED SCENERIO

PCI

1. BLOOD SPILL DRILL EVALN

2. BLOOD SPILL KIT

3. ICRA CHECKLIST AND PERMIT CONSTRUCTION; RENOVATION; DEMOLITION

4. TEMPERATURE AND HUMIDITY RECORD

5. TRAINING ATTENDANCE

6. WASTE DISPOSAL AUDIT TOOL

HK CLEANING CHECKLIST

1. GENERAL CSSD CLEANING CHECKLIST

2. GENERAL DAILY HOUSEKEEPING CLEANING CHECKLIST

3. TERMINAL ROOM CLEANING CHECKLIST

INFECTION CONTROL AUDIT CHECKLIST

1. ENVIRONMENTAL IC AUDIT CHECKLIST

2. HOUSEKEEPING INFECTION CONTROL CHECKLIST

3. LINEN SERVICES INFECTION CONTROL

1. JCI KPIs

   1. Critical Value Result Timely Reporting Compliance Rate - Lab | PRP:    Raw data of lab departmetns 

   2. Compliance rate of Turn Around Time for STAT/Urgent Laboratory Tests

   3. Compliance rate of Turn Around Time for Routine Laboratory Tests 

   4. Glucometer Quality Control compliance Rate

   5. Outsource Lab Test TAT Compliance Rate

   6. Lab Specimen Rejection rate

   7. Number of Reporting Errors per 1000 Investigations  

   8. Laboratory IQC Compliance Rate

   9. Laboratory EQAS Compliance rate

2. Documents Required

   1. GLUCOMETER DAILY QC CHECKLIST

   2. LAB- TEST REQUEST FORM

   3. REQUISITION FOR HISTOPATHOLOGICAL EXAMINATION

   4. CRIICAL VALUE, TELEPHONE, VERBAL ORDER RECEIVING FORM

   5. CRTICAL VALUE REGISTER TEMPLATE

1. JCI KPIs

   1. Patient Experience Rate - OPD & Health Check up Clinic 

Document Required

ACC

1.  ADMISSION AND DISCHARGE CRITERIA - LABOUR AND DELIVERY

2. ADMISSION AND DISCHARGE CRITERIA NICU-FINAL

3. ADMISSION AND DISCHARGE CRITERIA NICU

4. DISCHARGE PLANNING FORM

5. DISCHARGE SUMMARY

6. EXTERNAL TRANSFER FORM

7. INTERNAL REFERRAL FORM

8. PATIENT EXTERNAL REFERRAL FORM

PCC

1. CUSTOMER FEEDBACK, COMPLAINT FORM

2. PATIENT EXPERIENCE SURVEY

3. PATIENTS BILL OF RIGHTS-ENGLISH(MODEL)

1. JCI KPIs

   1. Medication error rate in OPD

   2. Incidence of medication errors (Prescription)  (OPD)

   3. Incidence of medication errors (Adminstering)  (OPD)

   4. Incidence of medication errors (Dispensing) - OPD

   5. Percentage of drug stock outs including emergency drugs

   6. Compliance rate to medication prescription in capitals - IP

   7. Compliance rate of appropriateness of indication for the new drugs

   8. STAT Medication administration compliance rate

   9. Compliance rate to medication prescription in capitals - OP

   10. Documents Required for JCI

       1. ADR MONITORING

       2. ADVERSE REACTION REPORTING FORM

       3. CONTRAST MEDIA ORDER

       4. CRASH CART DAILY MONTHLY CHECKLIST

       5. DECLARATION OF NEAR EXPIRY, RECALLED OR DAMAGED MEDICATIONS

       6. DRUG DELETION FORM

       7. DRUG RECALL FORM

       8. EVALUATION OF MEDICATION SUPPLIER COMPANY FORM

       9. FLOOR STOCK DAILY MEDICATION CHECKLIST

       10. FORMULARY APPLICATION SUBMISSION FORM

       11. MED STORAGE AREA AUDIT TOOL

       12. MEDICATION ERROR FORM

       13. MEDICATION ERROR MONITORING

       14. MEDICATION PRESCRIPTON AND ADMINISTRATION RECORD

       15. MEDICATION RECONCILIATION FORM

       16. NEWLY ADDED DRUG EVALUATION FORM

       17. NON-FORMULARY DRUG REQUEST FORM

       18. PATIENT OWN MEDICATION

       19. PHARMACY INTERVENTION REPORT

       20. PRESCRIPTION AUDIT FORM

       21. REFRIGERATOR TEMP LOG

       22. RESTRICTED ANTIMICROBIAL USE JUSTIFICATION FORM

1. JCI KPIs

   1. Percentage of drugs and consumables rejected before preparation of goods receipt Note [GRN]

   2. Incidence of variations from the procurement process

2. Documents Required

COP

1. CRASH CART DAILY CHECKLIST

2. CHEMOTHERAPY DRUG CHART

MMU

1. ADR MONITORING

2. ADVERSE REACTION REPORTING FORM

3. CONTRAST MEDIA ORDER

4. CRASH CART DAILY MONTHLY CHECKLIST

5. DECLARATION OF NEAR EXPIRY, RECALLED OR DAMAGED MEDICATIONS

6. DRUG DELETION FORM

7. DRUG RECALL FORM

8. EVALUATION OF MEDICATION SUPPLIER COMPANY FORM

9. FLOOR STOCK DAILY MEDICATION CHECKLIST

10. FORMULARY APPLICATION SUBMISSION FORM

11. MED STORAGE AREA AUDIT TOOL

12. MEDICATION ERROR FORM

13. MEDICATION ERROR MONITORING

14. MEDICATION PRESCRIPTON AND ADMINISTRATION RECORD

15. MEDICATION RECONCILIATION FORM

16. NEWLY ADDED DRUG EVALUATION FORM

17. NON-FORMULARY DRUG REQUEST FORM

18. PATIENT OWN MEDICATION

19. PHARMACY INTERVENTION REPORT

20. PRESCRIPTION AUDIT FORM

21. REFRIGERATOR TEMP LOG

22. RESTRICTED ANTIMICROBIAL USE JUSTIFICATION FORM

FMS

1. MEDICAL WASTE COLLECTION RECORDS

2. TEMPERATURE AND HUMIDITY RECORD

3. HAZARDOUS WASTE MATERIAL INVENTORY 

4. HAZMAT INVENTORY 

PCI

1. HAND HYGIENE COMPETENCY

2. HAND HYGIENE OBSERVATION TOOL

3. WASTE DISPOSAL AUDIT TOOL

4. NEEDLE STICK RECORD

5. TEMPERATURE AND HUMIDITY RECORD

INFECTION CONTROL AUDIT CHECKLIST

1. PHARMACY INFECTION CONTROL CHECKLIST

QPS

1. INCIDENT REPORTING FORM 

2. ACTION PLAN FORM

3. RCA_FRAMEWORK  JCI

4. RCA FRAME WORK 

5. RISK ASSESSMENT TEMPLATE

SQE

1. EMPLOYEE TRAINING CHECKLIST

2. TRAINING ATTENDANCE

3. DEPARTMENT ORIENTATION CHECKLIST

4. STAFF FILE COMPLETION CHECKLIST.

5. PRIMARY SOURCE VERIFICATION TEMPLATE

HR FILE - CATEGORY WISE REQUIREMENTS

1. HR FILE DOCUMENTS LIST

2. PROFESSIONAL WISE SQE REQUIREMENTS

3. SQE STAFF FILE LIST CATEGORY WISE

1. JCI KPIs

   1. Effectiveness of Physiotherapy Treatment for Pain Management

2. Documents Required

AOP

1. PHYSIOTHERAPY ASSESSMENT OP

2. PROGRESS NOTES

3. DOCTORS ORDER SHEET

OPD DR SPECIALTY WISE ASSESSMENT FORMS

1. PHYSIOTHERAPY ASSESSMENT OP

NURSING ASSESSMENT, REASSESSMENT

1. GENERAL NURSING ADMISSION ASSESSMENT

2. GENERAL NURSING ADMISSION REASSESSMENT

FALL SCREENING & ASSESSMENT

1. FALL RISK SCREENING

2. MORSE FALL RISK ASSESSMENT FORM

3. HUMPTY DUMPTY SCALE

NUTRITIONAL SCREENING & ASSESSMENT

1. NUTRITIONAL ASSESSMENT FORM

2. NUTRITIONAL SCREENING FORM

PHYSICIAN ADMISSION ASSESSMENT FORMS 

1. PEDIATRIC ADMISSION REASSESSMENT FORM.DOC

2. PEDIATRIC ASSESSMENT FORM.DOCX

SPECIAL POPULATIONS

1. INITIAL ASSESSMENT FORM NURSING - FRAIL ELDERLYGERIATRIC

COP

1. MULTIDISCIPLINARY CARE PLAN

2. PAIN FLOW SHEET

3. BEHAVIOURAL PAIN SCALE

4. FLACC TOOL

5. CPOT -PAIN SCREENING TOOL

6. BRADEN_SCALE - FOR PRESSURE ULCERS

7. DVT

8. RESTRAINT CONSENT FORM

9. RESTRAINT MONITORING FORM

10. RAPID-RESPONSE-TEAM-RECORD-FORM (1)

11. END OF LIFE CARE FORM(VERSION 1)

EWS TOOL

1. ADULT EARLY WARNING SIGNS

2. MATERNITY EARLY WARNING SIGNS

3. MEWS

4. PEAD EWS

IPSG

1. CRIICAL VALUE, TELEPHONE, VERBAL ORDER RECEIVING FORM

2. CRTICAL VALUE REGISTER TEMPLATE

3. DOCTORS HANDOVER FORM - REVISED

4. DUTY RMO SHIFT CHANGE HANDOVER FORM

5. NURSING HANDOVER FORM

6. NURSING SBAR

MMU

1. ADR MONITORING

2. ADVERSE REACTION REPORTING FORM

3. MEDICATION ERROR FORM

4. MEDICATION ERROR MONITORING

5. MEDICATION PRESCRIPTON AND ADMINISTRATION RECORD

6. MEDICATION RECONCILIATION FORM

7. PATIENT OWN MEDICATION

PCC

1. CUSTOMER FEEDBACK, COMPLAINT FORM

2. INTERDISCIPILINARY PATIENT FAMILY EDUCATION RECORD

3. PATIENT EXPERIENCE SURVEY

4. WAIVER FOR REFUSAL OF TREATMENT, MEDICATION, SERVICE

CONSENT FORMS

1. GENERAL CONSENT -ENG

2. INFORMED CONSENT FOR HIGH RISK

3. PHYSIOTHERAPY GENERAL CONSENT

FMS

1. WHEELCHAIRS SAFETY CHECKLIST

2. EQUIPMENT INVENTORY 

3. MAINTENANCE LOG 

4. TEMPERATURE AND HUMIDITY RECORD

5. MEDICAL GAS MONITORING SHEET 

6. FIRE EXTINGUISHER INSPECTION CHECKLIST 

7. FACILITY ROUNDS CHECKLIST - TEMPLATE 

DRILL EVALUATION FORMS 

1. CODE BLUE, DRILL EVALUATION LATEST

2. EXTERNAL DISASTER DRILL EVALUATION FORM

MOI

1. AUTHOIRIZATION FOR RELEASE OF MEDICAL RECORDS

2. DOCUMENT REQEST FORM

MEDICAL RECORD AUDIT 

1. MEDICAL RECORD REVIEW TOOL

2. CLOSEDS RECORD REVIEW AUDIT CRITERIA - PHYSIO

PCI

1. BLOOD BODY FLUID EXPOSURE FORM

2. HAND HYGIENE COMPETENCY

3. HAND HYGIENE OBSERVATION TOOL

4. INFECTION CONTROL PROGRAM STAFFING PLAN UPDATED

5. TRAINING ATTENDANCE

6. WASTE DISPOSAL AUDIT TOOL

HK CLEANING CHECKLIST

1. GENERAL DAILY HOUSEKEEPING CLEANING CHECKLIST

2. TERMINAL ROOM CLEANING CHECKLIST

INFECTION CONTROL AUDIT CHECKLIST

1. ENVIRONMENTAL IC AUDIT CHECKLIST

2. GENERAL INFECTION CONTROL CHECKLIST 1

3. HOUSEKEEPING INFECTION CONTROL CHECKLIST

QPS

1. RCA_FRAMEWORK  JCI

2. INCIDENT REPORTING FORM 

3. ACTION PLAN FORM

4. RISK ASSESSMENT TEMPLATE

5. MINUTES OF MEETING 

6. RCA FRAME WORK 

SQE

1. ANNUAL STAFF PERFORMANCE APPRAISAL FORM

2. DEPARTMENT ORIENTATION CHECKLIST

3. EMPLOYEE TRAINING CHECKLIST

4. NEW HIRE ORIENTATION CHECKLIST

5. PRIMARY SOURCE VERIFICATION TEMPLATE

6. SQE DATA COLLECTION TOOL (HOSPITAL)

7. STAFF FILE COMPLETION CHECKLIST.

8. STAFFING PLAN TEMPLATE

9. TRAINING ATTENDANCE

10. PHYSIOTHERAPHY EVALUATION FORM

MPE

1. MPE HR File Requirment

1. JCI KPIs

   1. Critical Value Result Timely Reporting Compliance Rate - Radiology

   2. Compliance rate of Turn Around Time for STAT/Urgent Radiology Test

   3. Compliance rate of Turn Around Time for Routine Radiology Tests 

   4. Percentage of Re-do's

   5. Outsource Imaging  Tests TAT Compliance Rate

   6. Number of Reporting Errors per 1000 Investigations 

2. Documents Required

   1. RADIOLOGY DECLARATION

   2. RADIOLOGY IMAGE QUALITY

   3. RADIOLOGY PEER REVIEW FORM

   4. RADIOLOGY PPE CHECKLIST

   5. RADIOLOGY-REQUEST-FORM

   6. RADIOLOGY QUALITY CONTROL PROGRAM DAILY SURVEILLANCE OF IMAGING RESULTS

   7. INFORMED CONSENT FOR CONTRAST

   8. CRIICAL VALUE, TELEPHONE, VERBAL ORDER RECEIVING FORM

   9. CRTICAL VALUE REGISTER TEMPLATE

   10.