Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX H.2
A.O. No. 2016-

CHECKLIST FOR REVIEW OF FLOOR PLANS

BIRTHING HOME

Name of Health Facility:

Address:
Date: Review: 1st

1. PHYSICAL PLANT
_ 1.1 General Administrative Service
_ 1.1.1 Waiting Area
_ .1.2 Business Area
1

_ 1.1.3 Consultation andTreatment Room

_ 1.1.4 Toilet and Bathroom
_ 1.1.5 Janitor's Closet
_1.2 GlinicalService
_1.2.1 Birthing Room
_1.2.1.1 Birthing Area
_1.2.1.2 Sterile and Supply Storage Area
Resuscitation Area with work rable
_1.22 Slriliff:lorn
_ 1.2.3 Clean-up and Sterilization Room
1.2.4Ward

2. PLANNING AND DESIGN

_2.1 Floor plans properly identified and completely labeled
Conforms to applicable codes as part of normal professional service:
Exits restricted to the following types: door leading directly outside the
-2.2 building, interior stair, ramp, and exterior stair
-22j Minimum of two (2) exits, remote from each other, for each floor of the
building
-2.2.2 Exits terminate directly at an open space to the outside of the building
Minimum of one (1) toilet on each floor accessible to the disabled
_2.3-2.2.3Meets prescribed functional programs:
-22A Main entrance of the birthing home directly accessible from public road
_2.2.2 Ramp for clinical services located on the upper floor.
-23'l 2.3.3 Admitting, records and business office located near the main entrance of the
birthing home
- Birthing Room located and arranged to prevent non-related traffic through the
room
-2.3.4 Scrub-up area recessed into an alcove or other open space out of the main
traffic.
COMMENTS: -2.3.5

G;;;;;---l
: Revision:oo :

i 12t1412016
::::::i:
i

i i
 Republic of the Philippines
Department of Health
HEALTH FAC ILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility:

Address:

COMMENTS:

HEALTH FACTLTTTES EVALUATTON AND REVTEW COMMTTTEE (HFERC)

[ ]Approved [ ]Disapproved

Chairperson, HFERC

Vice-Chairperson, HFERC

Member Member Member

Member Member Member