HCE PERFORMANCE MEASURING CHECKLIST FOR INCHARGE

Name of HCE: __________________________________________

Name of in charge: __________________________________ Designation: ______________________
Date of inspection: _____/_______/______ Time: ______________________________________

Weekly Monitoring Tasks Observation Recommendation

General Cleanliness
Washroom cleaned/Functional
Drinking Water available
Seating arrangement for patients
UPS/Generator functional
Staff Attendance:
Attendance register/Biometric/
Movement register/Leave register
Staff wearing identification
badges
Emergency room ready/ drug list/
essential supply
Oxygen cylinder filled/ready
Hospital waste disposed off
properly
Sterilization /Hand washing
facilities
Daily expense register
maintained
Patient registration/Guidance
system
Patients privacy ensured during
consultation/examination
Medicines are being labelled
while dispensing

Monthly /Quarterly Monitoring Observation Recommendation

Tasks
Medicine store:
 Storage as per guidelines
 Expiry dates
 Essential drug list updated
Equipment functional status
Fire-fighting arrangements
Record review focus on
Unique number, Completeness,
accuracy, Authorization, Legibility
Weekly/Monthly staff meetings
conducted/Minutes recorded
Complaint register
maintained/Reviewed
Any Sentinel event recorded
Display of IEC Material
High risk Obs Cases identification
and documentation
HCE/Patient rights charter
displayed
Leave register maintained

Number of PUBLIC OPINION

persons Unsatisfact No
Views contacted in ory Respons
Good Average
OPD/ Field e

1) Presence of Doctors/Staff
2) Attitude of staff towards
patients
3) Waiting Time

Note: Names and Contact Numbers of at least two persons interviewed during the visit

Sr. Name Address Contact Number

No.

GENERAL REMARKS

_____________________________________
Signature of In charge with Designation