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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.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

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Facility Checklist

Medical/Patient Care

Availability of other space for ancillary services. Examine general condition of facilities. Other experts will look at these areas from a different perspective.

Date: ____________  Location: _______________________  Team member: __________________________






Number of floors:  
Number of rooms per floor by type:  
General layout:  
Applicability of use:  
Existing fixed and removable equipment:  
Medical gas outlets description:  



Nurse call system?  
Telemetry system?  
Applicability for use:  


Medical/patient care issues:  


Licensing/accreditation issues:  


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The information on this page is archived and provided for reference purposes only.


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