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  2. 2015
  3. February
  4. R
  5. Rounding checklist
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Name
   
 
 
 
As Title/department
   
 
 
 
Date:
   
Time:
   
 
 
 
acknowledge (knock, announce)
 
Yes
 
No
 
N/a
 
 
 
introduction (name/title)
 
Yes
 
No
 
N/a
 
 
 
explanation/duration
 
Yes
 
No
 
N/a
 
 
 
thank the patient
 
Yes
 
No
 
N/a
 
 
 
professional and courteous
 
Yes
 
No
 
N/a
 
 
 
general appearance of room (neat,clean)
 
Yes
 
No
 
N/a
 
 
 
in regards to this hospital stay, would you rate this hospital a 9-10?
 
Yes
 
No
 
Unsure
 
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