Nursing Rounding Log Form
Log details of each nursing round, including patient care checks and interventions.
Date and Time of Round
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Nurse Name or ID
*
Unit/Ward
*
Please Select
Medical
Surgical
Pediatrics
ICU
Emergency
Other
Patient Room/Bed Number
*
Patient Initials (Non-sensitive)
*
Type of Round
*
Routine
Post-Procedure
Admission
Discharge
Other
Patient Status Observed
*
Please Select
Stable
Needs Attention
Critical
Sleeping
Other
Care Checks Completed
*
Pain Assessment
Comfort/Repositioning
Hygiene/Toileting
Safety Checks (rails, call bell)
IV/Lines Checked
Other
Interventions Performed
Medication Administered
Wound Care
Assisted Mobility
Provided Education
Other
Follow-up Actions or Notes
Submit Log
Should be Empty: