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Surge Tool Kit and Facility Checklist

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Facility Checklist

Facilities/Advanced Patient Care (continued)

Date: ____________  Location: _______________________  Team member: __________________________

Intensive Care Unit




General Condition:  


Description of Structural Components

Missing or damaged structural components (note location):  



Description and location:  



Nurse call system?  
Telemetry system?  





HVAC and Air Flow (ducts, vents, and radiators)

General condition:  


Air Flow:

Y N Sinks?
Y N Floor drains?


Fire Suppression:

Y N Sprinkler heads?
Y N Extinguishers?


Waste Management and Hazardous Materials:

Y N Containment and storage capability?
Y N On-site treatment/management set-ups?


Hazardous Materials Management (storage, use):

Y N Segregated hazardous wastes storage?
Y N Shielded radioactives storage?
Y N Eye washes, drench showers?
Y N Flammables cabinets?
Y N Compressed gases chains?


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