Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX H.gb
A.o. No. 2016- OA 4n

CHECKLIST FOR REVIEW OF FLOOR PLANS

CUSTODIAL PSYCHIATRIC CARE FACILITY

Name of Health Facility:

Address:

Date: Review: 1" 2nd 3ro

1. PHYSICAL PLANT
1.1 General Administrative Service
1.1.1 Waiting Area
1.1.2 Information, Reception and Business Office
_ 1.1.3 Dietary
_1.1.4 Dining Area
1.2 Gustodial Service
1.2.1 Nursing Unit
_1.2.1.1 Nurses' Work Area
_1.2.1.2 Patient Room
_ .2.1.3
1 Toilet
1.2.2 Psychosocial Unit
1.2.2.1 Indoor Activity Area
1.2.2.2 Outdoor Activity Area

PLANNING AND DESIGN

_21 Floor plans properly identified and completely labeled
2.2 Conforms to applicable codes as part of normal professional service:
2.2.1 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
2.3 Meets prescribed functional programs:
_2.l1 Main entrance of the facility directly accessible from public road
Separate rooms and toilets for male and female patients
_23.3 Nurses'work area located and designed to allow visual observation of
-23.2 patient and movement into the nursing unit
2.3.4 Toilet immediately accessible from each room in a nursing unit
COMMENTS:

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 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility:

Address:

GOMMENTS:

HEALTH FACILTTTES EVALUATION AND REVTEW COMMITTEE (HFERC)

[ ]Approved [ ]Disapproved

Chairperson, HFERC

Vice-Chairperson, HFERC

Member Member Member

Member Member Member

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