ffi Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

A.O. No. 2016-

ANNEX H-6a
DO+L-
CHECKLIST FOR REVIEW OF FLOOR PLANS
LEVEL 1 HOSPITAL

Name of Hospital:

Address:

Date: Review: 1st 2nd 3rd

1. PHYSICAL PLANT
_ 1.1 Administrative Service
_1.1.1 Lobby
_11.11 Waiting Area
_1.1.1.2 Information, Reception Area and Admifting Section
_1.1.1.3 Public Toilet (Male/Female/PWD)
_1.11.4 Staff Toilet
_1.1.2 Business Office
_1.1.3 Medical Records Office
_ 1.1.4 Prayer Areal Room
_1.1.5 Office of the Chief of Hospital
_1.1.6 Laundry* and Linen Secfibn
_1.1.7 Maintenance and Housekeeping Secfion*
_1.1.8 Parking Area for Transport Vehicle
_1.1.9 Supply Room
_1.1.10 Waste Holding Room
_1.1.11 Dietary*
|.1.11.1 DietitianArea
SuPPIY Receiving Area*
1.1.11.3 Cold and Dry Storage Area*
1.1.11.4
-:.1-11.2 Food Prepaiation Aiea*
1.1.11.5 Cooking and Baking Area*
Serving and Food Assembly Area
I
.1.1'1.7 Washing Area
-:.1-11.6 1.8 Garbage Disposal Area
- Dining Area
-:.1.11.1.11.10 Toilet
1 . 1-l
-:'1'11'9
2 Cadaver Hol d n g Room
i

_1.2 ClinicalService
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_1.2.1 Emergency Room
_1.2.1.1 Waiting Area
_1.2.1.2 Toilet
_1.2.1.3 Nurses'Station with Work Area with Lavatory/Sink
_1.2.1.4 Minor Operating Room/Surgical Area
_1.2.1.5 Examination and Treatment Area with Lavatory/Sink
_1.2.1.6 Observation Area
_1.2.1.7 Equipment and Supply Storage Area
_1.2.1.8 Wheeled Stretcher Area

*When the services are contracted out, these areas are not required. However, a contract of service or
memorandum ofagreement with a service provider should be secured as a prerequisite for license to operate.

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 1.2.2 Outpatient Department (Separate from ER Complex)

- _1.2.2.1 Waiting Area

_1.2.2.2 Toilet (Male/Female/PWD)
_ 1.2.2.3 OPD Nurses' Station with work area with Lavatory/sink
_ 1.2.2.4 OPD Medical Records Secfion
_ 1.2.2.5 Consultation Area
_1.2.2.6 Examination and Treatment Area with Lavatory/Sink
(OB, Medicine, Pedia, Surgery, Dental-optional)
_1.2.3 Surgical and Obstetrical Service
_1.2.3.1 Major Operating Room
_1.2.3.2 Labor Room with toilet
_123.3 Delivery Room
_123.4 Recovery Room
1.2.3.5 Sub-sterilizing AreaMork Area
1.2.3.6 Sterile Instrument, Supply and Storage Area
-
_1.2.3.7 Scrub-up Area
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_1.2.3.8 Clean-up Area
_1.2.3.9 Dressing Room
_1.2.3.10 Toilet
Nurses' Station with Work Area
_1.2.3.12 Wheeled Stretcher Area
-1.2.3.11 Janitor's Closet (with mop sink)
_1.2.4 Nursing Unit
-1.2.3.13
_1.2.4.1 Patient Room with toilet
1.2.4.2 lsolation Room wlfh Toilet and Ante Room with sink, PPE
Rack and hamper
_1.2.4.3 Nurses' Station with Medication Area with Lavatory/Sink
_1.2.4.4 Treatment Area
_1.2.5 Central Sterilizing and Supply Room
Receiving and Cleaning Area
lnspection and Packaging Area
-j.2.5.1
_1.2.5.3 Sterilizing Room
-].2.5.2
1.2.5.4 Storage and Releasing Area
_ 1.3 Nursing Service
- Office of the Chief Nurse
_ 1.3.1
_1.4 Ancillary Service
_1.4.1 Secondary Clinical Laboratory with Blood Station
1.4.1.1 Clinical Work Area with Lavatory/Sink
( min. Floor Area: 20.00 sq.m.)
-
_1.4.1.2 PathologistArea
_1.4.1.3 Toilet
_ 1.4.1.4 Extraction Area Separate from Clinical Lab. Work area
_1.4.2 Radiology - 1st Level
1.4.2.1 X-Ray Room with Control Booth, Dressing Area and
Toilet
-_1.4.2.2 Dark Room
1.4.2.3 Film File and Storage Area
_1.4.2.4 Radiologist Area
_1.4.3- Pharmacy (with work counter and sink)

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2.PLANNING AND DESIGN
_21 Floor plans properly identified and completely labeled
_2.2 Conforms to applicable codes as part of normal professional service:
_221 Exits restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair
_ZZ2 Minimum of two (2) exits, remote from each other, for each floor of the
building
_2.2.3 Patient Corridors for ingress and egress shall be at least 2.44 meters in
clear and unobstructed width
_2.2.4 Exits terminate directly at an open space to the outside of the building
_2.2.5 Minimum of one (1) toilet on each floor accessible to the disabled
_2.3 Meets prescribed functional programs:
_2.3.1 Main entrance of the hospital directly accessible from public road
_2.3.2 Ramp or elevator for clinical, nursing and ancillary services located on
the upper floor
_ 2.3.3 Ad m inistrative 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
_2.3.42 Separate entrance to the emergency
_2.3A.3 Ramp for wheelchair access (with a clear width of at least
1.22 m. or 4 ft.)
_2.3.4.4 Easily accessible to the clinical and ancillary services
(laboratory, radiology, pharmacy, operating room)
_2345 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 to
ensure easy access for patients
_235.2 Separate toilets for patients and staff (Male/Female/PWD)
_2.3.6 Surgical and Obstetrical Service
_23.6.1 Located and arranged to prevent non-related traffic
through the suite
_2.3.6.2 Operating room and delivery room located as remote
as practicable from the entrance to the suite to
provide greater asepsis
_ 2.3.6.3 Operating room and delivery room arranged to
prevent staff and patients to travel from one area to
the other area
_23.6.4 Dressing room arranged to avoid exposure to dirty
areas after changing to surgical garments
_ 2.3.6.5 Nurses' station located to permit visual observation of
patient and movement into the suite
_ 2.3.6.6 Scrub-up area recessed into an alcove or other open
space out of the main traffic
_2.3,6.7 Sub-sterifizing area shallbe provided and shallbe accessible
from the Operating room and delivery room
 _2.3.7 Nursing Service
_2.3.7.1 Nurses' station located and designed to allow visual
observation of patient and movement into the nursing unit
_23.7.2 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
_23.7.3 Toilet immediately accessible from each room in a nursing unit
_ 2.3.7.4 Separate rooms with toilets 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
_ 2.3.8.1 The dietary service shall be away from morgue with
at least 25-meter distance

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

Name of Health Facility:

Address:

GOMMENTS:

HEALTH FACTLTTTES EVALUATTON AND REVTEW COMMITTEE (HFERC)

[ ]Approved [ ]Disapproved

Chairperson, HFERC

Vice-Chairperson, H FERC

Member

Member Member w

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