Clinical Unit Handover Checklist Form
Use this form to record and confirm key items during a clinical unit handover.
Handover Details
Handover Date
*
-
Month
-
Day
Year
Date
Shift Type
*
Day
Evening
Night
Other
Handing-over Unit/Ward
*
Receiving Unit/Ward
*
Staff Member Completing Handover (Name/Role)
*
Clinical Handover Checklist
Patient and ward status reviewed
*
Yes
No
Outstanding tasks reviewed
*
Yes
No
Pending investigations reviewed
*
Yes
No
Medication changes reviewed
*
Yes
No
Equipment or supply issues noted
*
Yes
No
Incident or escalation points reviewed
*
Yes
No
Follow-up actions assigned
*
Yes
No
Exceptions and Acknowledgment
Unresolved issues or special instructions
Acknowledgment
*
I confirm the handover information has been reviewed and passed on accurately
Submit
Should be Empty: