HOSPITAL DAILY MONITORING CHECKLIST (WRITE YES/NO) DATE/TIME

Checked by : date (Enclose remarks of improvement if any as per Guidelines on

www.health.mp.gov.in)
1 1. . O OP PD D 6 6. . D Di i a ag gn no os s t ti i c c F Fa ac ci i l l i it ty y
1.1 Reception & Help Desk - Patient guidance, Information
regarding services & Doctor.

6 6. .1 1 P Pa at th ho ol lo og gy y L La ab b

1.2 Registration - Availability as per made of staff,
stationary, prescription slips, HMIS (Hospital statistics).
6.11 Staff
6.12 Equipments & their functioning status.

1.3 Senior Citizen Counter display. 6.13 Consumables
1.4 Complaint Box. 6.14 Whether range of investigation is
consistent with the Medical Services
provided.

1.5 Chambers of Doctors & Specialist, Patient's sitting
arrangement, Patient disposal.
6.15 Reports - whether being released in time
to O.P.D/Wards.

1.6 Dispensary- Availability of drugs, Pharmacist, duty
roster.

6 6. .2 2 R Ra ad di io o I I m ma a g gi in ng g

1.7 Grievance Redressal by RMO/ Superintendent. 6.21 X-Ray/CT Scan Machine & functioning
status.

1.8 Minor O.T. - Dressing material, instruments, sterilised
drums, Gloves etc.
6.22 Availability and Quality of Fixer
developer, X-Ray Film.

1.9 Plaster Room, Injection Room- Availability of material
& performance status.
6.23 USG - Functioning status.
6.24 Radiation Safety officer nominated.

1.10 Referral Register 6.25 Reports- whether being released in time to
OPD/Ward.

1.11 Enquire whether Patients are getting Medicine or Not. 6.26 Status of Radiation Protection Protocol,
Badges is being regularly used.

2 2. . C Ca au us s a al l i it ty y

7 7. . S St to or re e

2.1 Availability of Doctor, Nurse, compounder, other
support staff Duty Roster. CMO daily report.
7.1 Store Keeper/Pharmacist - Availability.


2.2 Availability of emergency tray having drugs, oxygen,
Ambubag, suction, equipment functioning, support staff,
Duty Roster.
7.2 Storage of Drugs in order, cleannes.


2.3 Status of emergency ward. 7.3 Security status.

2.4 Skill of Medical/paramedical in life saving practices
emergency ward, emergency Box having drugs stitching
material, dressing material for Disaster.
7.4 Drugs- sample stock check, expiry
(FEFO).

3 3. . D Di is s p pe en ns s a ar ry y

8 8. . O O. .T T/ /I IC CU U


3.1 Availability of sufficient drug stock.

8.1 Anaesthetist - Specialist/ M.O.
8.2 Support staff

3.2 Stock Book entry, Daily expenditure entry verification. 8.3 Functioning status of Equipment.
8.4 Duty Roster, OT checklist, Infection
Control Measures -fumigation / Culture
swabs.

3.3 Drug dispensing in envelops. 8.5 Emergency/OT Drugs/sterilization of
linen/instrument.

4 4. . H H. .R R. . s s t ta at tu us s c ch he ec ck k A At tt te e n ndda an nc cee

9 9. . L La ab bo ou ur r R Ro oo om m


4.1 Medical, Para Medical 9.1 Availability of Staff, Drugs, Five trays.
4.2 Support staff, Behaviour of staff among colleagues and
with patient.
9.2 Availability & status of Resuscitation
equipment

5 5. . A Am mb bu ul la an nc ce e

9.3 Status of Labour Table, Mattress
Macintosh.

5.1 24x7 Availability & functioning, Diesel, Petrol. 9.4 Cleanliness Status, Availability of dustbins,
water supply etc.

5.2 Driver - Available round the clock.


5.3 Daily Log Book verification.


HOSPITAL DAILY MONITORING CHECKLIST (WRITE YES/NO) DATE/TIME
Checked by : date (Enclose remarks of improvement if any as per Guidelines on
www.health.mp.gov.in)
1 10 0. . W Wa ar rd ds s - -



10.1 Status of Mattress, Sheets, Drugs.
1 17 7. . P Pa at t i ie en nt t' ' s s/ /AAt tt t e e n nd da a n nt t' 's s f fe ee ed d b ba ac ck ks s f fo or r
s sa at t i is sf fa ac ct to or r y y t t r re ea at t m me en nt t. .

10.2 Staff - Regular Rounds by Medical Officer/Specialist to
be ensured.

1 18 8. . C Ca ar re e o of f D De ea ad d/ /M Mo or r t tuua ar r y y a ar rr ra a n ng ge e m me en nt ts s / /
P Po os st t- - m mo or rtte e m m. .. .

10.3 Record Keeping- Drugs, Case sheet etc.
1 19 9. . H Ho os sp pi it ta al l F Fu ur r n ni it t u ur re e- - w wo oo odde e n n, , s st te ee el l, ,
Rusted Furniture & remedial measures

10.4 Nursing & support staff.
2 20 0. . H Ho os sp pi it ta al l W Wa as st te e M Ma an na ag ge e m me e n nt t

10.5 Enquire patients regarding services behaviour of the
staff.

2 20 0. .1 1 C Co ol l l le ec ct t i io on n


1 11 1. . H Ho ou us se e K Ke ee e p pi i n ng g

2 20 0. .2 2 S Se eg gr re eg ga at t i io on n
11.1 OPD 2 20 0. .3 3 M Ma a i in nt t e en na an nc ce e o of f R Re ec co or rd d
11.2 Wards


2 20 0. .4 4 T Tr ra an ns s p po or rt ta at t i io on n

11.3 OT/ICU

2 20 0. .5 5 D Di is s p po os s a al l- - i i f f i in n- -h ho ou us s e e w wh he et t h he er r p pr ro ot t o oc co ol l i is s
o ob bs se er rv ve ed d. .

11.4 L.R.
2 20 0. .6 6 D De es st t r ru uc ct t i ioon n & & D Di is s p po os sa al l o of f s sh ha ar rp ps s. .

11.5 Premises


2 20 0. .7 7 D De esst t r ru uc ct t i io on n & & D Di is s i in nf fe ec ct t i io on n o of f r ru ub bb be er r, , g gl la as s s s & &
P Pl la as s t t i ic cs s . .

11.6 Drainages
2 20 0. .8 8 C Co ollo ou ur rs s c co od de ed d B Bi in ns s a ar re e i in n p pl la ac ce e i in n O OP PD D, , i in n
w wa arrd ds s , , i in n i in nj je ec ct t i io on n r ro oo om m e et tcc. .

11.7 Toilets cleanliness, Lights
2 20 0. .9 9 R Re eg gu ul la ar r C Ch ha an ng gi in ng g o of f p po ol ly yt t h he en ne es s . .

11.8 Toilets for OPD patients, use of Disinfectants.
2 20 0. .1 10 0 U Us see o of f p pr ro ot t e ec ct t i iv ve e g ge ea ar r, , b bo oo ot ts s , , a ap pr ro on n e et t c c b by y
w wa asst t e e h ha annd dl li in ng g s s t t a af ff f. .

1 12 2. . W Wa at te e r r S Su uppp pl ly y 2 21 1. . O Ob bs se e r rv va an nc ce e & & P Pr ra ac ct t i ic ce e o of f I I n nf fe e c ct ti io on n
C Co on nt t r ro ol l P Pr ro ot to oc co ol ls s . .

12.1 Drinking water RO/Aqua guard.
2 21 1. .1 1 I In n O O. . T T. .

12.2 Water Cooler- Maintenance.
2 21 1. .2 2 I In n I I C CU U

12.3 Overhead tanks
2 21 1. .3 3 I In n L L. . R R. .


12.4 Taps & fittings, Leakages.
2 21 1. .4 4 H Ha an nd d w wa as sh h P Pr ra ac ct t i ic ce e

12.5 Washroom
2 21 1. .5 5 P Pr ro ot te ec ct t i iv ve e g gl lo ov ve es s , , a ap pr roon n e et t c c

12.6 Washbasins


1 13 3. . E El le e c cttr ri ic c S Su up pp pl ly y

2 22 2. . R Re e c co or rd d R Ro oo om m

13.1 General- Switches, wiring, Lights.
2 22 2. .1 1 C Cl le ea an nl l i in ne es ss s/ / p pe es stts s / / R Ro od de en nt ts s

13.2 Generator- Functional status.
2 22 2. .2 2 P Pr ro op pe er r f f i i l li in ng g s s t t o oc ck ki in ng g


13.3 Availability of Electrician during routine/Emergency
Hours.




1 14 4. . D Di ie e t t



1 14 4. .1 1 A Av va ai i l la ab bi i l li it t y y o of f S St ta af ff f



1 14 4. .2 2 A Av va ai il la ab b i il l i it t y y o of f F Fo oo od d i it t e emms s & & T Ti i m mi in nggs s o of f F Fo oo od d s su up pp pl ly y. .



1 14 4. .3 3 U Ut t e en ns si il ls s - - A Av va ai il la abbi i l l i it t y y && C Cl le eaan nl l i in ne es s s s . .



1 14 4. .4 4 F Fo oo od d T Tr ro o l ll le ey y



1 14 4. .5 5 W Wa at t e er r s s u up pp pl ly y



1 14 4. .6 6 G Ge en ne er ra al l C Cl le ea an nl l i in ne es s s s



1 15 5. . H Ho os s p pi it t a al l S Si ig gn na ag ge e, , D Di is s p pl la ayy B Bo oa ar rd ds s , , T Ti im mi in ng gs s d di is s p pl laay y. .



1 16 6. . F Fi i r re e f f i ig gh ht t i in ng g E Eq qu ui ip pm me en nt t




HOSPITAL DAILY MONITORING CHECKLIST (WRITE YES/NO) DATE/TIME
Checked by : date (Enclose remarks of improvement if any as per Guidelines on
www.health.mp.gov.in)

REMARKS OF HOSPITAL SUPERINTENDENT/ INCHARGE: