Pediatrics Daily Checklist
Complete this checklist to ensure comprehensive daily care and monitoring for pediatric patients.
Patient Full Name
*
First Name
Last Name
Patient ID or Medical Record Number
*
Date of Checklist
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Temperature (°C)
*
Heart Rate (beats per minute)
*
Respiratory Rate (breaths per minute)
*
Medication Administered
Antibiotics
Analgesics
Antipyretics
Other
Feeding/Nutrition
*
Breastfeeding
Formula feeding
Solid foods
NPO (nothing by mouth)
Other
Symptoms/Observations
Fever
Cough
Vomiting
Diarrhea
Rash
Other
Hygiene Activities Completed
Diaper change
Bathing
Oral care
Other
Safety/Environment Check
Bed rails up
Call bell within reach
Hazards removed
Other
Mobility/Activity Level
Bed rest
Assisted movement
Independent movement
Additional Notes/Comments
Submit Checklist
Should be Empty: