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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 It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work.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/General Interior

A thorough inspection of the internal facility to determine structural and operational readiness or to suggest maintenance and repairs to achieve readiness.

Date: ____________  Location: _______________________  Team member: __________________________

General (including condition of interior, space, number of rooms, licenses, current uses, and age)




Current approved uses:  





Current licensing/accreditation
(if any):


Estimated interior square footage:

Original patient capacity:


Number of Rooms

Operating rooms:  
Intensive care units:  


Estimated surge capacity:  


Potential areas for ward use:  


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


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