ICU Patient Communication Board Checklist Form
Use this checklist to verify the proper setup and readiness of the ICU patient communication board.
Patient's Room Number
*
Date of Checklist Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is the communication board present at the bedside?
*
Yes
No
Is the board easily visible and accessible to the patient?
*
Yes
No
Not applicable
Are communication tools (e.g., marker, eraser) available and functional?
*
Yes
No
Not applicable
Is the patient's preferred communication method indicated on the board?
*
Yes
No
Unknown
Are all sections of the board (pain scale, needs, staff names, etc.) completed?
*
All sections completed
Some sections incomplete
Board not completed
Is the board content updated for the current shift?
*
Yes
No
Not applicable
Are staff aware of the patient's communication needs and board use?
*
Yes
No
Not applicable
Additional comments or observations (optional)
Submit Checklist
Should be Empty: