HOUSE OF HOPE FOUNDATION INC.UPPER PATALAN, LUMBIA, CAGAYAN DE ORO CITY

SCHOOL:_____________________DATE & SHIFT:________________STUDENT OD:_________________CLINICAL INSTRUCTOR:_______________________

AM CHECKLISTActivities and Assigned Areas Accomplished Please Check Remarks

1.) Have all the patients done their bathing?2.) Have the patients done with their morning exercise?3.) Have you done assisting / doing patients personal hygiene-care?4.)Have you supervised or helped patients doing assigned household chores?

NOTE: Items being referred above must be submitted to the House of Hope staff by C.I before therapy at 9:00 A.M Items being referred below must be submitted to the House of Hope assigned by C.I. before departure at 11:00 A.M

5.) After care: A). Activity Area: chairs filed one over the other, undo posted materials and decoration, etc. Well swept floor Facilities borrowed (M/F ward, Isolation Cells), chairs, tables Other specify B). Stock Room (Pls. Check the area) Well ordered clothes, toiletries, etc. Chemical elements – well arranged and returned, pls specify6.) Remember to return all borrowed items: keys, patient’s chart, microphone/ sound system, ID’s Others, pls. specify:7.) Others: A). Wash Room: kept dry B). Office/ Nurse station: Personal belongings – claimed before dismissal (if any)

Checked by: Noted by:

___________________________________ _______________________________________ Clinical Instructor House of Hope Staff

HOUSE OF HOPE FOUNDATION, INC.UPPER PALALAN, LUMBIA, CAGAYAN DE ORO CITY

SCHOOL:_______________________DATE & SHIFT:__________________STUDENT OD:___________________CLINICAL INSTRUCTOR:___________________________

PM CHECKLISTActivities and Assigned Areas Accomplished Please Check Remarks

1.) After care: Therapy Area: Chairs filed one over the other Undo posted materials and decoration, etc Well swept floor Facilities borrowed (M/F ward, Isolation Cells), chairs, tables Working area for Medication Preparation2.) Have you facilitated the patient’s rosary prayer?3.) Have all patient’s done their bathing and washing?4.) Have you done assisting / doing patient’s personal hygiene – care? 5.) Have you supervised or helped patient’s doing assigned household chores?6.) After care: Stock room – assess the area for well ordered clothes, toiletries, etc. Chemical elements – well arranged & returned, please specify7.) Remember to return all borrowed items: Keys, patient’s chart, microphone/ sound system, ID’s Others, pls. specify:8.) Others: A). Wash Room: kept dry B). Office/ Nurse station: Personal belongings – claimed before dismissal (if any)

Note: This checklist must be submitted to the HOH staff. Signed by C.I before departure @ ________________

Checked by: Noted by:

____________________________________ _______________________________________ Clinical Instructor House of Hope Staff