Unit/Department Specific Orientation & Training Checklist

Unit Name______

CONTACT /NAMES/NUMBERS Nurse Manager Assistant Nurse Manager Clinical Nurse Specialist/Clinical Practice Leader Unit Number Pharmacy Charge phone Housekeeping: Respiratory

CODES Med Room Supply Closets Med Carts Staff Locker Room Supply room Nutrition Room Clean/soiled utility

Instructions for Use:  This template is to be utilized for staff Unit/Department Specific Orientation & Training  Place a check  in the indicated column once the orientation item is complete.  No down arrows or continuous lines permitted.  Write “N/A” in the indicated column if an item is not applicable to the employee role or unit. Covid-19 Patient  or N/A Negative pressure verification (ball in the Room Prep wall) Special Respiratory Isolation sign on door Elevators to be used Don/Doff Checklist in room Travel path to O.R.s N/A Isolation cart with appropriate PPE TB01/TB02 biohazard trash cans inside Isolation and PPE room PAPR cart location Red biohazard trash can outside room Additional PPE Location (doff into red trash cans) Contact/droplet: gown, gloves, masks, eye Door closed protection Sign in sheet (send to Occ. Med. when Covid-19 Patient  or N/A complete) Isolation and PPE cont. Covid-19 Patient  or N/A N95 use only for aerosol generating Facilities and Safety procedures (open suctioning, intubation,

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nebulizers, Bipap etc.) Med room refrigerators

Microwave Tele Monitors Phillips Phone number lists Unit bed capacity Pro Pack Room Numbers Pneumatic tube system Unit Phone Number Scale Charge book and computer Waste bins blue/black Bladder Scanner Unit Set up Ultrasound machine Clean Utility PATIENT ROOM ORIENTATION  or N/A Conference/break rooms Ceiling Lift Dirty utility room Computer / Work Area Elevator, Passenger Emergency Power Outlets Elevator. Service Family Area / Sleep Couch / Chair Equipment Storage room Headwall / Booms ( Lights, Oxygen, Family waiting room Suction)

Fax Machine Patient Bed

Lab label machines Patient Communication Board

Linen chute Patient Phones

Locker room Patient Restroom

Med rooms Patient TV

Nurse manager’s office ROLE SPECIFIC/ SPECIALTY  or N/A CNS and Assistant Nurse Manager office CONSIDERATIONS Nutrition Room Central Monitoring Station Omni Cell Charge Nurse Station Staff Bathrooms Charts – Shadow/ Current Admission Staff Lounge Communication Device/ Docking Visitor bathrooms Downtime Manual Nutrition Room Unit Date EMERGENCY EQUIPMENT/ RESPONSE  or N/A Employee Name: Code pull stations in rooms Code carts Defibrillator Employee Number:

Disaster plan EKG machine Employee Signature: Gas Shut off valve

Fire Safety  or N/A Manager name: Alarms Exits Manager Signature: Extinguishers

Fire doors

Floor plan

Miscellaneous  or N/A Assignment sheets Glucometers

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