• The Joint Commission Triennial Survey Guidelines for taking notes: Note the name and history number of any patient involved in tracer activity Staff information: note name, role, unit, and badge number where possible of anyone the surveyor speaks to and/or anyone whose notes they review in a chart Note anytime the location changes Write verbatim notes (questions/issues/suggestions made by the surveyor) Please note the top 3-5 issues in the Additional Information section at the conclusion of your tracer

  • Document No.

  • Site/Area (Inpatient, Ambulatory, Behaviorlal, Life Safetyetc.)

  • Conducted on

  • Prepared by

Quick Reference Phone Number Virtual Command Center: Veronica Johnson 410-502-2133

Surveyor Team

  • Surveyor Name:

  • Scribe Name:

  • Staff Interviewed (include name, role and badge #):

  • Survey Area (Note when location changes):

  • MRN# of Charts Reviewed:

Tracer Information

  • Verbatim Notes:

  • Add media

  • Summary of Major Concerns/ Issues:

  • Add media

  • Positive/ Compliments to Individuals:

  • Add media

  • Additional Notes:

  • Add media

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