Patient Handling Safety Observation Checklist

Rows	Safe	Unsafe	N/A
Performed egress test prior to mobilizing patient
Check to see what equipment the label specifies
Pathways clear of trip hazards
Minimum of 3-4 staff for CLOF 1, 2, or 3, repositioning and/or lateral transfers
Proper lift equipment or HoverMatt used
Working in the “strike zone”
Rails dropped when tending to patient
Encourage patient participation

Location
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date
MonthDayYear
Print Name
First NameLast Name
Patient’s CLOF
Should be Empty: