Nursing Shift Handover Checklist Form
Complete this form to ensure clear and safe transfer of patient care between nursing shifts.
Patient Room or Bed Number
*
Patient Initials
*
Primary Diagnosis or Reason for Admission
*
Current Patient Status
*
Stable
Requires Monitoring
Deteriorating
Critical
Allergies
*
None known
Drug allergy
Food allergy
Latex allergy
Other (specify below)
Recent Changes or Events (last shift)
Outstanding Tasks for Next Shift
Special Equipment in Use
IV Line
Oxygen Therapy
Catheter
Feeding Tube
None
Other (specify below)
Safety or Infection Control Concerns
Falls risk
Isolation required
Pressure injury risk
None identified
Other (specify below)
Additional Notes
Submit Handover
Should be Empty: