Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • MRN

  • Nurse in visual

  • Nurse in triage

Triage Documentation


  • Visual triage documented accuratelly


  • Use of appropriate and complete assessment tool.

  • Ensure correct total score and in plan of care including fall prevention and precautions is to be implemented. Ensure preventive actions and interventions are ticked

  • General consent completed

  • Main complaints documented

  • PAIN ASSESSMENT, REASSESSMENT documented accurately

  • Sepsis Screening accurately done according to the Sepsis pathway and activated accordingly

  • Triage Acuity and triage completed

  • Height and weight documented accurately

  • Patient allergy reviewed

  • Home Medication reviewed

  • Patient history reviewed and documented

  • Re-triage or reassessment of vital sign completed if indicated

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