DATE

SEREMI
8-22 Valparakso Region
ESTABLISHMENT NAME
FOLIO NUMBER
CHECKLIST FOR FORMALIZATION OF
Ministry of

Health PROCEDURES ROOM

INFRASTRUCTURE
INFRASTRUCTURE RESOURCE FIELD : ACCESSIBILITY
Requirements FULFILLS
YEAH NO N/A
48 At least one door in the main access 12 of each building where patients are treated is accessible 13
autonomously and independently from the sidewalk level for the circulation of wheelchairs and for the
assisted circulation of stretchers.
49 The stairs have handrails
Observations:

INFRASTRUCTURE FIELD: GENERAL SAFETY CONDITIONS

Requirements FULFILLS
YEAH NO N/A
50 Enclosures, areas and surfaces free of humidity and/or leaks
51 Walls, doors, floors and clinical work surfaces and bathrooms are washable
52 Safe electrical installations 14 for users
53 Sanitary installations, including appliances and taps working, without leaks
54 Authorized drinking water supply system
55 Authorized wastewater disposal system
56 The establishment has parking space for ambulances/transport vehicles.
57 Evacuation routes 15 are completely clearly marked 16
58 The safe spaces to which evacuations will be conducted are defined.
59
The evacuation routes are free of equipment or elements that prevent the movement of
people
60 The establishment has operational fire extinguishers according to the DS. 594/99
61 It has a storage area for clinical supplies and medications with physical barriers to prevent the entry
of vectors of health interest or their elimination.
Observations

INFRASTRUCTURE SCOPE: GENERAL PREMISES

Requirements FULFILLS
YEAH NO N/A
The establishment has the following rooms, which may be common for several procedure and/or
consultation rooms:
62 Waiting room
63 Hygienic services for public and staff
64 Buildings have at least 1 universal wheelchair-accessible bathroom
65 Staff locker room
66 Staff canteen
67 . Archive
68 Wineries
69 Toilet sector and temporary garbage deposit
Observations

INFRASTRUCTURE AREA: ROOM FOR CONSULTATION WITH EXAMINATION

Aim:
Have facilities that allow interviews with the patient and his companions; physical exam on the stretcher.
Requirements FULFILLS
YEAH NO N/A
70 Examination stretcher 17
71 Footstool
72 A sink
73 Registration desk
74 Chairs

12 In existing constructions, a secondary access can be enabled, with proper signage.

13 The door must have a minimum free width of 0.90 m; impact resistant up to a height of not less than 0.30 m, and may not be rotatable. The way of
The circulation that connects the door with the sidewalk must allow the transit of wheelchairs and stretchers. A deadline can be granted and a work plan
requested for authorization
14 Refers to visible sockets and wiring inside the enclosures.
15 Evacuation route: horizontal, inclined or vertical circulation of a building, which allows the fluid exit of people in emergency situations,
from the access of each unit to a risk-free outdoor space, connected to public roads (OGUC)
16 This is not a requirement for the health authorization for installation and operation, it can be granted with a suggestion with a reasonable period for its
completion.
implementation.
PROCEDURES ROOM 1
INFRASTRUCTURE AREA: PROCEDURE ROOM
Objective: Have facilities that allow therapeutic diagnostic procedures to be carried out. Among them: treatments, cures,
procedures
Requirements FULFILLS
YEAH NO N/A
The procedure room has:
75 Stretcher
76 Footstool
77 It has devices for organizing facilities and equipment
78 Furniture to store clean and sterile clinical supplies
79 Clean area with washable surface separated from dirty area
80 A sink
81 Instrument table
82 Focused lighting at the work point (procedure lamp)
83 Dirty area with washable surface and deep Washing Tank for temporary storage of instruments in
use, separated from the clean material preparation counter
84 If minor surgery interventions limited to what is indicated in note 18 are performed in the Procedure
Room of a health center with a referral network, the following must be available:
85 Healing Instrumental Set, Minor Surgery Box-Set, Electroscalpel, Ward Clothing
86 In case of carrying out records, a support surface for records and statistics is required separate from
the clean work desk.
OBSERVATIONS:

PROCEDURES ROOM 2

17 The patient's privacy must be protected by: appropriate location of the stretcher within the box, direction of door opening, safety lock.
door closure, partitions, screens, or other option).
18 It includes simple and short-term procedures, under local anesthesia and that addresses benign lesions smaller than 5 cm, including:
Onysectomies, lipomectomies, pailectomies: removal of sebaceous and synovial cysts, nevus, warts, angiomas, pyogenic granuloma, fibromas and
INFRASTRUCTURE AREA: PROCEDURE ROOM
various biopsies. APS Resolving Program 2008. Primary Care Division
Objective: Have facilities that allow therapeutic diagnostic procedures to be carried out. Among them: treatments, cures,
procedures
Requirements FULFILLS
YEAH NO N/A
The procedure room has:
75 Stretcher
76 Footstool
77 It has devices for organizing facilities and equipment
78 Furniture to store clean and sterile clinical supplies
79 Clean area with washable surface separated from dirty area
80 A sink
81 Instrument table
82 Focused lighting at the work point (procedure lamp)
83 Dirty area with washable surface and deep Washing Tank for temporary storage of instruments in
use, separated from the clean material preparation counter
84 If minor surgery interventions limited to what is indicated in note 18 are performed in the Procedure
Room of a health center with a referral network, the following must be available:
85 Healing Instrumental Set, Minor Surgery Box-Set, Electroscalpel, Ward Clothing
86 In case of carrying out records, a support surface for records and statistics is required separate from
the clean work desk.
OBSERVATIONS:

17 The patient's privacy must be protected by: appropriate location of the stretcher within the box, direction of door opening, safety lock.
door closure, partitions, screens, or other option).
PROCEDURES ROOM 2
18 It includes simple and short-term procedures, under local anesthesia and that addresses benign lesions smaller than 5 cm, including:
Onysectomies, lipomectomies, pailectomies: removal of sebaceous and synovial cysts, nevus, warts, angiomas, pyogenic granuloma, fibromas and various biopsies.
APS Resolving Program 2008. Primary Care Division
PROCEDURES ROOM 3
INFRASTRUCTURE AREA: PROCEDURE ROOM
Objective: Have facilities that allow therapeutic diagnostic procedures to be carried out. Among them: treatments, cures,
procedures
Requirements FULFILLS
YEAH NO N/A
The procedure room has:
75 Stretcher
76 Footstool
77 It has devices for organizing facilities and equipment
78 Furniture to store clean and sterile clinical supplies
79 Clean area with washable surface separated from dirty area
80 A sink
81 Instrument table
82 Focused lighting at the work point (procedure lamp)
83 Dirty area with washable surface and deep Washing Tank for temporary storage of instruments in
use, separated from the clean material preparation counter
84 If minor surgery interventions limited to what is indicated in note 18 are performed in the Procedure
Room of a health center with a referral network, the following must be available:
85 Healing Instrumental Set, Minor Surgery Box-Set, Electroscalpel, Ward Clothing
86 In case of carrying out records, a support surface for records and statistics is required separate from
the clean work desk.
OBSERVATIONS:

17 The patient's privacy must be protected by: appropriate location of the stretcher within the box, direction of door opening, safety lock.
door closure, partitions, screens, or other option).
18 It includes simple and short-term procedures, under local anesthesia and that addresses benign lesions smaller than 5 cm, including:
Onysectomies, lipomectomies, pailectomies: removal of sebaceous and synovial cysts, nevus, warts, angiomas, pyogenic granuloma, fibromas and
various biopsies. APS Resolving Program 2008. Primary Care Division

INFRASTRUCTURE AREA: TOILET 47

Objective: Provide space to clean and store materials and equipment used in cleaning the premises.
Requirements FULFILLS
YEAH NO N/A
180. The establishment has at least one space for cleaning and storing materials and equipment used in
cleaning the premises.
181. This space has the following conditions:
182. Deep wash tank
183. Space for storage of work supplies 48
184. Containers for temporary deposits of solid waste, waterproof and with lids.

INFRASTRUCTURE SCOPE: PREMISES DISPOSAL OF SOLID WASTE FROM THE ESTABLISHMENT

Aim:
Have facilities and personal protection implements to handle and store waste until it is removed from the establishment, which
contribute to reducing the risk of contamination of users and staff.
Requirements FULFILLS
YEAH NO N/A
185. There is an area of temporary deposits for storing the establishment's waste.
186. This area has the following characteristics:
187. It is a closed space 49
188. Container washing system
189. The establishment has containers for the elimination of household waste, through an authorized
transportation and final disposal system.

Name and signature of the Name and signature of the representative of the
Inspector establishment