Review

Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
CHECKLIST FOR REVIEW OF FLOOR PLANS
LEVEL 1 HOSPITAL

Name of Hospital ________________________________________________________________

Address ___________________________________________________________________________________

Date ___________________________
1st ____ 2nd ______ 3rd ______

1 PHYSICAL PLANT
____ 1.1 Administrative Service
____ 1.1.1 Lobby
____ 1.1.1.1 Waiting Area
____ 1.1.1.2 Information and Reception Area
____ 1.1.1.3 Public Toilet (Male/Female/PWD)
____ 1.1.1.4 Staff Toilet
____ 1.1.2 Business Office
____ 1.1.3 Medical Records Room
____ 1.1.4 Prayer Area
____ 1.1.5 Office of the Chief of Hospital
____ 1.1.6 Laundry* and Linen Area
____ 1.1.7 Maintenance and Housekeeping Area*
____ 1.1.8 Parking Area for Transport Vehicle
____ 1.1.9 Supply Room
____ 1.1.10 Waste Holding Room
____ 1.1.11 Dietary*
____ 1.1.11.1 Dietitian Area
____ 1.1.11.2 Supply Receiving Area*
____ 1.1.11.3 Cold and Dry Storage Area*
____ 1.1.11.4 Food Preparation Area*
____ 1.1.11.5 Cooking and Baking Area*
____ 1.1.11.6 Serving and Food Assembly Area
____ 1.1.11.7 Washing Area
____ 1.1.11.8 Garbage Disposal Area
____ 1.1.11.9 Dining Area
____ 1.1.11.10 Toilet*
____ 1.1.12 Cadaver Holding Room
____ 1.2 Clinical Service
____ 1.2.1 Emergency Room
____ 1.2.1.1 Waiting Area
____ 1.2.1.2 Toilet
____ 1.2.1.3 Nurse Station
____ 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

*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.

Form-HOS-PTC-CR-L1
Revision:04
02/16/2016
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 ____ 1.2.1.8 Wheeled Stretcher Area
____ 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 Admitting and Records Area
____ 1.2.2.4 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
____ 1.2.3.3 Delivery Room
____ 1.2.3.4 Recovery Room
____ 1.2.3.5 Sub-sterilizing Area/Work Area
____ 1.2.3.6 Sterile Instrument, Supply and Storage Area
____ 1.2.3.7 Scrub-up Area
____ 1.2.3.8 Clean-up Area
____ 1.2.3.9 Dressing Room
____ 1.2.3.10 Toilet
____ 1.2.3.11 Nurse Work Area
____ 1.2.3.12 Wheeled Stretcher Area
____ 1.2.3.13 Janitor’s Closet
____ 1.2.4 Nursing Unit
____ 1.2.4.1 Patient Room
____ 1.2.4.2 Toilet
____ 1.2.4.3 Isolation Room with Ante Room and Toilet
____ 1.2.4.4 Nurse Station
____ 1.2.4.5 Treatment and Medication Area with Lavatory/Sink
____ 1.2.5 Central Sterilizing and Supply Room
____ 1.2.5.1 Receiving and Releasing Area
____ 1.2.5.2 Work Area
____ 1.2.5.3 Sterilizing Area
____ 1.2.5.4 Sterile Supply Storage Area
____ 1.3 Nursing Service
____ 1.3.1 Office of the Chief Nurse
____ 1.4 Ancillary Service
____ 1.4.1 Secondary Clinical Laboratory
____ 1.4.1.1 Clinical Work Area with Lavatory/Sink
____ 1.4.1.2 Pathologist Area
____ 1.4.1.3 Toilet
____ 1.4.2 Blood Station

____ 1.4.3 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
____ 1.4.4 Pharmacy

Form-HOS-PTC-CR-L1
Revision:04
02/16/2016
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2
PLANNING AND DESIGN
____ 2.1 Floor plans properly identified and completely labeled
____ 2.2 Conforms to applicable codes as part of normal professional service:
____ 2.2.1Exits restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair
____ 2.2.2Minimum of two (2) exits, remote from each other, for each floor of the
building
____ 2.2.3Corridors and ramps for ingress and egress 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 Administrative 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
____ 2.3.4.2 Separate entrance to the emergency
____ 2.3.4.3 Ramp for wheelchair access
____ 2.3.4.4 Easily accessible to the clinical and ancillary services
(laboratory, radiology, pharmacy, operating room)
____ 2.3.4.5 Nurse 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
____ 2.3.5.2 Separate toilets for patients and staff (Male/Female/PWD)
____ 2.3.6 Surgical and Obstetrical Service
____ 2.3.6.1 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
reduce traffic and 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
____ 2.3.6.4 Dressing room arranged to avoid exposure to dirty
areas after changing to surgical garments
____ 2.3.6.5 Nurse 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-sterilizing area separate from the operating room
and accessible to the clean-up area
____ 2.3.7 Separate toilets and rooms for male and female patients

Form-HOS-PTC-CR-L1
Revision:04
02/16/2016
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COMMENTS:

____ 2.3.8 Nursing Service

____ 2.3.8.1 Nurse station located and designed to allow visual
observation of patient and movement into the nursing
unit
____ 2.3.8.2 Nurse station provided in all nursing units of the
hospital with a ratio of at least one (1) nurse station
for every thirty-five (35) beds
____ 2.3.8.3 Toilet immediately accessible from each room in a
nursing unit

____ 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

Form-HOS-PTC-CR-L1
Revision:04
02/16/2016
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 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility

Address:

COMMENTS:

HEALTH FACILITIES EVALUATION AND REVIEW COMMITTEE (HFERC)

[ ] Approved [ ] Disapproved

ATTY. RODEL C. FLORES

Chairperson, HFERC

ENGR. RODELIO A. PINEDA

Vice-Chairperson, HFERC
Member Member Member

Form-HOS-PTC-CR-L1
Revision:04
02/16/2016
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