Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX H.6b
A.O. No. 2016- OO4L
CHECKLIST FOR REVIEW OF FLOOR PLANS
LEVEL 2 HOSPITAL

Name of Health Facility:

Address:
Date: Review: 1"t 2nd 3'd

1. PHYSICAL PLANT
_ 1.1 Administrative Service
_1.1.1 Lobby
_1.1.1.1 Waiting Area
_1.1.1.2 Information, Reception and Communication Area
_ 1.1.1.3 Public Toilet (Male/Female/PWD)
_ 1.1.1.4 Staff Toilet (Male/Female)
_1.1.2 Admitting and Social Service Office
_ 1.1.3 Business Office
_ 1.1.3.1 Billing
_1.1.3.2 Cashier
_ 1.1.3.3 Budget and Finance
_ 1.1.4 Medical Records Section
_ 1.1.5 Personnel Office
_ 1.1.6 Prayer Room
_1.1.7 Office of the Administrative Officer
_1.1.8 Office of the Chief of Hospital
_ 1. .9 Office of the Chief of Clinics
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_1.1.10 Conference and Training Room

_1.1.11 Library
_1.1.12 Staff Toilet
_1.1.13 Laundry* and Linen Office
_1.1.13.1 Sorting and Washing Area*
_1.1.13.2 Pressing and lroning Area*
_ 1.1.13.3 Storage Area
_ 1. 1. 14 Maintenance Office"
_1.1.14.1Work Area*
_ .1.14.2 Housekeeping Area*
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_1.1.14.3 Motorpool* and Ambulance Parking Area

_1.1.15 Property and Supply Office
_1.1.16 Waste Holding Room
_1.1.17 Dietary*
_ .1.'17 .1 Dietitian Office
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_1.1.17.2 Supply Receiving Area*

_ .1.17.3 Cold and Dry Storage Area*
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_1 .1.17 .4 Food Preparation Area*

_1.1.17.5 Cooking and Baking Area*
_1.1.17 .6 Serving and Food Assembly Area
*When the services are contracted out, these areas are not required. However, a contract of service or
memorandum of agreement with a service provider should be secured as a prerequisite for license to operate.
 _ .1.17.7 Washing Area
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_1.1.17.8 GarbageDisposalArea
_1.1.17.9 Dining Area
_1.1.17 .10 Toilet
_1.1.18 Cadaver Holding Area
1.2 GlinicalService
_12.1Emergency Room
_1.2.1.1 Waiting Area
_1.2.1.2 Toilet
_1.21.3 Nurses'Station
_ 1.2.1.4 Triage
_12.1.5 Minor ONArea
_1.2.1.6 Examination and Treatment Area with Lavatory/Sink
_1.2.1.7 ObservationArea
_1.2.1.8 lsolation Room with Toilet and Ante Room with PPE Rack, Sink
or Lavatory
_1.21.9 Equipment and Supply Storage Area
_ .2.1.10 Wheeled Stretcher Area
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_ 1.2.2 Outpatient Department

_1.2.2.1 Waiting Area
_1.2.2.2 Toilet
_1.2.2.3 Admitting and Records Area
_1.2.2.4 ConsultationArea
_1.2.2.5 Respiratory Unit
_1.2.2.6 Examination and Treatment Area with Lavatory/Sink
_1227 DentalClinic
_1.2.2.8 Office of the Department Head
_ .2.2.8.1Medicine
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_1.2.2.8.2 Pediatrics
_ 1.2.2.8.3 Obstetrics and Gynecology
_1.2.2.8.4 Surgery and Anesthesia
_ 1.2.3 Surgical Service
_1.2.3.1 Major Operating Room
_1.2.3.2 Recovery Room wlfh Nurses'Work Area
_1.2.3.3 Sub-sterilizingAreaMorkArea
_1.2.3.4 Sterile Instrument, Supply and Storage Area
_1.2.3.5 Scrub-up Area
_1.2.3.6 Clean-up Area
_12.3.7 Male Dressing Room and Toilet
_1.23.8 Female Dressing Room and Toilet
_1.2.3.9 Nurses' StationMork Area
_ .2.3.10 Wheeled Stretcher Area
1

_1.2.3.11 Janitor's Closet with mop sink

_ 1.2.4 Obstetrical Service
_1.2.4.1 Delivery Room
_ 1.2.4.2 High Risk Pregnancy Unit
_1.2.4.3 Labor Room with Toilet
1.2.4.4 Sub-sterilizingAreaMorkArea
_1.2.4.5 Sterile Instrument, Supply and Storage Area
_1.2.4.6 Scrub-up Area
_1.2.4.7 Clean-up Area
_1.2.4.8 Male Dressing Room and Toilet
_1.2.4.9 Female Dressing Room and Toilet
_1.2.4.10 Nurses' StationMorkArea
_1.2.4.'11 Wheeled StretcherArea
_1.2.4.12 Janitor's Closet with mop sink
1.2.5 Neonatal lntensive Care Unit (NICU)
_ 1.2.5.1 Nurses' StationtWork Area with Sink
 _ 1.2.5.2 Newborn Care Area
_ 1.2.5.3 Breastfeeding Area with Lavatory
_ 1.2.5.4 Treatment Area
viewins Area
_1.ru *.,;1;11",,
_1.2.6.1 Patient Room with toilet
_1.2.6.2 lsolation Room wifh toilet and Ante Room with PPE Rack,
SinULavatory and hamper
_1.2.6.3 Nurses'Station
_ 1.2.6.3.1 Utility Area
_1.2.6.3.2 Linen Area
_1.2.6.3.3 Toilet
and Medication Area with Lavatory/sink
_ 1.r.,
"l3ru#
I,',iittent
_1.2.7.1
""r" Nurses' Station with Work Area with Lavatory/Sink
_1.2.7.2 MedicationPreparationArea
_1.2.7.3 Toilet
_1.2.7.4 Patient Area
_1.2.7.5 Dressing Area

_1.r-8c.ii:t&"'iri,i.,?Tffi Hffi t:upprvstoraseArea

_1.2.8.1 Receiving and Cleaning Area
_1.2.8.2 lnspection and Packing Area
_1.2.8.3 Sterilizing Room
storase and Reteasins Area
_ 1.3
_ "*r#1;?;1
1.3.1 Office of the Chief Nurse
_1.3.2 Toilet
_1.4 Ancillary Service
_ 1.4.1 Tertiary Clinical Laboratory
_1.4.1.1 ClinicalWork Area with Lavatory/Sink(mrn. of 60.00 sq.m.)
_1.4.1.2 PathologistArea
_1.4.1.3 MicrobiologyRoom
_1.4.1.4 Extraction Area separate from Clinical Work Area
roiret
1 4-.2Btol";i /,8,",
_ 1.4.3 Radiology - 2nd Level
- _1.4.3.1 X - Ray Room with Control Booth, Dressing Area and
Toilet
_1.4.3.2 Dark Room
_ 1.4.3.3 Film File and Storage Area

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2. -1 ^2il;i;!!,
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 Exits restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair
_222 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
_22.4 Exits terminate directly at an open space to the outside of the building
_225 Minimum of one (1) toilet on each floor accessible to the disabled
_23 Meets prescribed functional programs:
_23.1 Main entrance of the hospital directly accessible from public road
_2.3.2 Ramp or elevator for clinical, nursing and ancillary services located on
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_ 2.3.3 Administrative Service
Business office located near the main entrance of the
hospital
_2.3A-2.3.3.1
Emergency Room
_23.41 Located in the ground floor to ensure easy access for
patients
_2.34.2 Separate entrance to the emergency
_23A.3 Ramp for wheelchair access
(with clear width of at least 1.22m. or 4ft.)
_23.4.4 Easily accessible to the clinical and ancillary services
(laboratory, radiology, pharmacy, operating room)
_2.3.4.5 Nurses' station located to permit observation of patient
and control of access to entrance, waiting area, and
treatment area
_ 2.3.5 Outpatient Department
_2.35.1 Located near the main entrance of the hospital to
ensure easy access for patients
_235.2 Separate toilets for patients and staff
_ 2.3.6 Surgical Service
Located and arranged to prevent non-related traffic
through the suite
-2.3.6.1
_2.3.6.2 Operating room located as remote as practicable
from the entrance to the suite to provide greater asepsis
_ 2.3.6.3 Dressing room arranged to avoid exposure to dirty
areas after changing to surgical garments
Nurses' station located to permit visual observation of
patient and movement into the suite
_ 2.3.6.5
-23.6.4 Scrub-up area recessed into an alcove or other open
space out of the main traffic
2.3.6.6 Sub-sterilizing area shall be provided and accessible
from the operating room
-_23.6.7 Recovery room located within the suite in an area
near the entrance to the suite
_2.3.7 Delivery Service
_23.7.1 Located and arranged to prevent non-related traffic
through the suite
_23.7.2 Delivery room located as remote as practicable from
the entrance to the suite to provide greater asepsis
Dressing room arranged to avoid exposure to dirty
areas after changing to obstetric garments
-2.3.7.3 Nurses' station located to permit visual observation of
patient and movement into the suite
2.3.7.5 Scrub-up area recessed into an alcove or other open
-2.3.7.4
space out of the main traffic
2.3.7.6 Sub-sterilizing area shall be provided and accessible from the
delivery room
2.3.7.7 Delivery room and NICU located on the same floor
2.3.7.8 NICU separate but immediately accessible from the
delivery room

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 _2.3.8 Nursing Service
2.3.8.1 Nurses' station located and designed to allow visual
observation of patient and movement into the nursing
unit
2.3.8.2 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
2.3.8.3 Toilet immediately accessible from each room in a
nursing unit
2.3.8.4 Separate toilets and rooms for male and female patients
_2.3.9 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
2.3.9.1 The dietary service shall be away from morgue with
at least 25-meter distance

COMMENTS:

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i Revision:OO i
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 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility:

Address:

GOMMENTS:

HEALTH FACtLtTtES EVALUATTON AND REVIEW COMMITTEE (HFERC)

[ ]Approved [ ]Disapproved

Chairperson, HFERC

Vice-Chairperson, HFERC

Member Member

Member Member Member

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