Policy & Procedure Review

Are there any regulatory standards for restraints?

What are some of those standards?

Is there a clear definition of a restraint?

Does this address patients with law enforcement restraints applied?


Who is allowed to order/prescribe restraint use?

Is there any requirement for notifying family of the patient when restraints are going to be used?

Does current documentation specify the locations where restraints are to be applied? (2 point, 4 point vs. Right wrist, Left ankle)

Who is allowed to remove a restraint?

Is there training documentation on team members who can apply and/or remove restraints?

What is the process for removing restraints for treatments, transport, feeding, etc.?

Chart Review

Medical Chart of Patient in Restraints

Medical Record

Do the orders specify which location(s) restraints are to be applied?

Are the orders for non-violent patients renewed each calendar day?

Monitoring is completed every 2 hours for non-violent behavior

Plan of Care is reviewed/updated daily.

HR and Training File Review

Personnel File Review

Team Member

Team Member Initials:

Team member has completed training on restraints

Date of last training session:
Quality Monitoring

Data Analysis is being conducted and reviewed for compliance with policy and for continuous improvement.

Restraint log includes date and time of order

Team Members who have not received training are not applying or removing restraints

Date and time of death associated with restraints is being recorded.



Finding or Opportunity For Improvement

Standard Not Being Met:


Recommended Corrective Action:

Opportunity For Improvement




Notable Effort

Recognition for exemplary efforts



Additional Notes
Auditor Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.