ISPT TRIAGE CHECKLIST (Level 1 & 2)

• Conducted on

  Date

• Prepared by

• Location
  Address

LEVEL 1 TRIAGE

Parameters

• Knowledge of the level of security guard on what to check and questions to ask

  Yes

  No

  N/A

• Essential Health Measures

  Yes

  No

  N/A

Essential Health Measures

• Face masks

  Yes

  No

  N/A

• Social Distancing

  Yes

  No

  N/A

• Hand Washing

  Yes

  No

  N/A

• Coughing Etiquettes

  Compliant

  Non-Compliant

  N/A

• PPE by Health Care Workers ( HCW ) Frontliners

• Use of Mask

  Yes

  No

  N/A

• Coordination to the 2nd Level

  Yes

  No

  N/A

CONCERNS :

• What happens to patients and watchers before 8 o’clock?

LEVEL II TRIAGE

• PPE of Health Care Workers (HCW )

  Yes

  No

  N/A

• Turn Around Time

  Date

• Level of Knowledge of the Team

  Yes

  No

  N/A

• Work Place Condition

  Yes

  No

  N/A

• Triaging Process from Stretcher Borne/ Critical Patients

  Yes

  No

  N/A

CONCERNS :

• What happens to patients and watchers before 8 o’clock?