Form HOS-PTC-CR/L1-2007 Republic of the Philippines Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila Trunk Line: 743-83-01; Direct Line: 711-9572; Fax: 781-4179 URL: http://www.doh.gov.ph/
CHECKLIST FOR REVIEW OF FLOOR PLANS LEVEL 1 HOSPITAL Name of Hospital Address Date 1
Review
1st
2nd
3rd
PHYSICAL PLANT ____ 1.1 Administrative Service ____ 1.1.1 Waiting Area ____ 1.1.2 Admitting and Records Area ____ 1.1.3 Administrative and Business Office ____ 1.1.4 Staff Toilet ____ 1.1.5 Parking Area for Transport Vehicle ____ 1.2 Clinical Service ____ 1.2.1 Emergency and Outpatient ____ 1.2.1.1 Waiting Area ____ 1.2.1.2 Toilet ____ 1.2.1.3 Nurse Station ____ 1.2.1.4 Consultation Area ____ 1.2.1.5 Examination and Treatment Area with Lavatory/Sink ____ 1.2.1.6 Equipment and Supply Storage Area ____ 1.2.1.7 Wheeled Stretcher Area ____ 1.2.2 Birthing Room ____ 1.2.2.1 Birthing Area ____ 1.2.2.2 Scrub-up Area ____ 1.2.2.3 Newborn Area with Lavatory/Sink ____ 1.2.2.4 Equipment and Supply Storage Area ____ 1.3 Nursing Service ____ 1.3.1 Nurse Station ____ 1.3.2 Patient Room ____ 1.3.3 Toilet PLANNING AND DESIGN ____ 2.1 Floor plans properly identified and completely labeled ____ 2.2 Conforms to applicable codes as part of normal professional service: ____ 2.2.1 Exits restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair ____ 2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the building ____ 2.2.3 Exits terminate directly at an open space to the outside of the building ____ 2.2.4 Minimum of one (1) toilet on each floor accessible to the disabled ____ 2.3 Meets prescribed functional programs: ____ 2.3.1 Main entrance of the infirmary directly accessible from public road ____ 2.3.2 Ramp for clinical, nursing and ancillary services located on the upper floor
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Form HOS-PTC-CR/L1-2007
____ 2.3.3
____ 2.3.4
____ 2.3.5
____ 2.3.6 ____ 2.3.7
Administrative Service ____ 2.3.3.1 Administrative and business office located near the main entrance of the infirmary Emergency and Outpatient ____ 2.3.4.1 Located in the ground floor to ensure easy access for patients ____ 2.3.4.2 Ramp for wheelchair access ____ 2.3.4.3 Nurse station located to permit observation of patient and control of access to entrance, waiting area, and treatment area ____ 2.3.4.4 Separate toilets for patients and staff Birthing Room ____ 2.3.5.1 Located and arranged to prevent non-related traffic through the room ____ 2.3.5.2 Scrub-up area recessed into an alcove or other open space out of the main traffic Separate toilets and wards for male and female patients Nursing Service ____ 2.3.7.1 Nurse station located and designed to allow visual observation of patient and movement into the nursing unit ____ 2.3.7.2 Toilet immediately accessible from each room in a nursing unit
COMMENTS:
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Form HOS-PTC-CR/L1-2007 Republic of the Philippines Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila Trunk Line: 743-83-01; Direct Line: 711-9572; Fax: 781-4179 URL: http://www.doh.gov.ph/
Name of Hospital Address RECOMMENDATION: [ [ ] ] Approved Disapproved Date Date
REVIEWED AND EVALUATED BY:
Engr. HERMINIO G. DIONCO Chairperson
Dr. MA. BRENDA C. PANCHO Vice-Chairperson
Engr. RODELIO A. PINEDA / Engr. JUN JORGE O. SORIANO Member
Engr. AIDA M. ANGELES / Engr. NELEEN A. ANINO Member
Arch. EFREN C. LOPEZ / Arch. ANNABELLE C. SOTTO Member
Ms. ROSE MYLENE A. SOTOCINAL / Dr. LILIBETH M. VALEZA Member
Mr. JOSELYN T. VIORGE / Ms. NILDA B. SILVERA Member
Mr. ALFONSO A. FAVIS Member
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