Republic of the Philippines Department of Health HEALTH FACILITIES AND SERVICES REGULATORY BUREAU ANNEX H-6b A.O.No. 2016- 0042 CHECKLIST FOR REVIEW OF FLOOR PLANS LEVEL 2 HOSPITAL Name of Health Facility ‘Address: Date: Review: a ae 1. PHYSICAL PLANT 1.1 Administrative Service 444 Lobby 1.4.1 Waiting Area 4.1.1.2 Information, Reception and Communication Area 4.4.1.3 Public Toilet (Male/Female/PWD) 1.1.1.4 Staff Tolot (Male/Female) imiting and Social Service Office HLL iti 7 ess Office 31 Billing 3, Cashier 3, Budget and Finance jedical Records Section Personnel Office Prayer Room Office of the Administrative Officer Office of the Chief of Hospital Office of the Chief of Clinics 10 Conforenee and Training Room 14. 14 11 aga HILLEL 1 2 Staff Toilet 3 Laundry* and Linen Office Sorting and Washing Area* Pressing and Ironing Area* Storage Area aintenance Office” 1.1.16.1 Work Area” 1.1.14.2 Housekeeping Area" 1.1.14.3 Motorpool* and Ambulance Parking Area Property and Supply Office Waste Holding Room Dietary" 14.474 Dietitian Office ‘Supply Receiving Area” Cold and Dry Storage Area" Food Preparation Area” Cooking and Baking Area" Serving and Food Assembly Area au alg LLL ‘Wen the services are contracted out, these ares are not required. However, a contac of sevice or ‘memorandum of agreement with a service provider should e secured as a prerequisite fr license to operate Phosrecriz | Bias he tet.al LLL 4121.4 121.9 12.1.10 1224 1222 1223 1224 1225 1226 1227 1228 Washing Area Garbage Disposal Area Dining Area Toilet 1.1578 Cadaver Holding Area TZClinical Service 4.2.1 Emergency Room Waiting Area Toilet Nurses’ Station Triage Minor OR/Area Examination and Treatment Area with Lavatory/Sink Observation Area Isolation Room with Toilet and Ante Room with PPE Rack, Sink or Lavatory Equipment and Supply Storage Area Wheeled Stretcher Area Z Outpationt Department Waiting Area Toliet ‘Admitting and Records Area Consultation Area Respiratory Unit Examination and Treatment Area with Lavatory/Sink Dental Cinic Office of the Department Head 1228.4 Medicine 1228.2 Pediatrics 1122.83 Obstetrics and Gynecology 1.22.84 Surgery and Anesthesia 1.2.3 Burgical Service “1.231 Major Operating Room "1232 Recovery Room with Nurses’ Work Area 1233 Sub-steriizing AreaMWork Area 1234 Sterile instrument, Supply and Storage Area 71235 — Scrub-up Area 1236 Clean-up Area 1237 Male Dressing Room and Toilet 1238 Female Dressing Room and Toilet = Nurses’ Station/Work Area a Wheeled Stretcher Area —__ Janitor's Closet with mop sink 1.24 Dbstetrical Service 1.2.4.1 Delivery Room 1.24.2 High Risk Pregnancy Unit 1243 Labor Room with Toilet 71244 Sub-steriizing AreaWork Area 12.45 Sterile instrument, Supply and Storage Area T1248 Serub-up Aree 21287 Clean-up Area == 1248 Male Dressing Room and Toilet 1249 Female Dressing Room and Toilet 12.410 Nurses’ StationWork Area 12.411 Wheeled Stretcher Area 112.412 Janitor's Closet with mop sink ‘B Neonatal Intensive Care Unit (NICU) 12.5.1 ‘Nurses’ Station/Work Area with Sink Rove Papel1.252 Newborn Care Area = 1253 Breastfeeding Area with Lavatory = 1254 Treatment Area 71255 Viewing Area 1.2.6 Nursing Unit 1.2.6.1 Patient Room with toilet == 12.62 Isolation Room with tollet and Ante Room with PPE Rack, Sink/Lavatory and hamper 1263 Nurses’ Station —_"1.2.6.3.1 Uilty Area 1263.2 Linen Area 1126.3:3 Toilet 126.4 Treatment and Medication Area with Lavatory/Sink 1.27 Imensive Care Unit “1.27.4 Nurses’ Station with Work Area with Lavatory/Sink 127.2 Medication Preparation Area exam 2173) | Tolel 1274 Patient Aree 71275 Dressing Area 12.7.6 Equipment and Supply Storage Area Central Sterlizing and Supply Room 1.281 Receiving and Cleaning Area 4.282 Inspection and Packing Area 1283 Sterilizing Room 1.284 Storage and Releasing Area 1.3 Nursing Service 1.8.1 Office of the Chief Nurse 1.32 Toilet Ancillary Service 4.4.1 Tertiary Clinical Laboratory 1.4.4.1” Clinical Work Area with Lavatory/Sinkj(min. of 60.00 sq.m.) 1412 Pathologist Area 14:13 Microbiology Room T1444 Extraction Area separate from Clinical Work Area 141.5 Toilet 1.42 Blood Station = 1.4.3 Radiology - 2 Level 1.43.1” X~Ray Room with Control Booth, Dressing Area and Toilet 143.2 Dark Room 1433 Film File and Storage Area 143.4 Radiologist Area 1.44 Pharmacy with work counter with sink 2. PLANNING AND DESIGN 2.4 Floorplans properly identifed and completely labeled 222 Conforms to applicable codes as part of normal professional service 2.2.1 Exits restricted tothe folowing types: door leading directly outside the building, interior staie, ramp, and exterior stair ____2.2.2 Minimum of two (2) exits, remote from each other, for each floor ofthe building 22:8 Patient corridors for ingress and egress shall be at least 2.44 meters in clear and unobstructed with ___ 2.2.4 Exits terminate directly at an open space to the outside ofthe building == 2.25 Minimum of one (1) tolet on each floor accessible tothe disabled 23 Meets prescribed functional programs: 2.3.1'Main entrance of the hospital directly accessible from public road = 2'32 Ramp or elevator for cincal, nursing and ancillary services located on the upper floor Miestrcents "Braaore Prant6,2.3.3 Aaministratve Service 2.3.3.1 Business office located near the main entrance of the hospital 2.3.4 Emergency Room 2.3.4.1 Located in the ground floor to ensure easy access for, patients 2342 Separate entrance to the emergency = 23.43 Ramp for wheelchair access (with clear width of at least 1.2m. or 4f.) 2.3.4.4 Easily accessible to the clinical and ancilary services (laboratory, radiology, pharmacy, operating room) 2.3.45 Nurses’ station located to permit observation of patient ‘and control of access to entrance, waiting area, and treatment area 2.3.5 Outpatient Department “2.3.5.1 Located near the main entrance of the hospital 0 ensure easy access for patients 2352 Separate toilets for patients and staff ___ 2.88 Surgical Service 2.3.6.1 Located and arranged to prevent non-related trafic through the suit 2.8.6.2 Operating room located as remote as practicable {rom the entrance to the suite to provide greater asepsis 2.36.3 Dressing room arranged to avoid exposure to dirty ‘areas after changing to surgical garments 2.3.6.4 Nurses’ station located to permit visual observation of patient and movement into the suite 2.3.6.5 —Scrub-up area recessed into an alcove or other open space out ofthe main traffic 2.366 Sub-steriizing area shall be provided and accessible {rom the operating room 2.3.8.7 Recovery room located within the suite in an area near the entrance to the suite 2.37 Delivery Service "2.3.71 Located and arranged to prevent non-related traffic through the suite 2.3.72 Delivery room located as remote as practicable from the entrance to the suite to provide greater asepsis, 2.3.7.3 Dressing room arranged to avoid exposure to dirty areas afier changing to obstetric garments 2.3.74 Nurses’ station located to permit visual observation of patient and movement into the suite 2.3.7.5 Sorub-up area recessed into an alcove or other open ‘space out of the main traffic 2.3.7.8 — Sub-sterlzing area shall be provided and accessible from the delivery room 2.3.7.7 Delivery room and NICU located on the same floor 23.7.8 NICU separate but immediately accessible from the delivery room L Baan2.3.8 Nursing Service 2.3.8.1 Nurses’ station located and designed to allow visual ‘observation of patient and movement into the nursing unit 2.3.8.2 Nurses’ station provided in all nursing units of the hospital with a ratio of at least one (1) nurses’ station for every thirty-five (35) beds 2.38.3 Toilet immediately accessible from each room ina rursing unit) 2384 Separate tollets and rooms for male and female patients __ 2.3.8 Dietary, maintenance and other non-patient contact services located in areas away from normal traffic within the hospital, or located in separate buildings within the hospital premises 2.3.9.1 The dietary service shall be away from morgue with at least 26-meter distance Revisondo Feae ct) Republic of the Philippines :) Department of Health 5} HEALTH FACILITIES AND SERVICES REGULATORY BUREAU Name of Health Facility Address: COMMENTS: HEALTH FACILITIES EVALUATION AND REVIEW COMMITTEE (HFERC) [1 Approved [| Disapproved Chairperson, HFERC Member Member Member Member Member Member Lest