Hospital Infant Security System Evaluation Questionnaire Form
Use this form to evaluate the hospital infant security system, rate key features, and note observations for improvement.
Evaluation Details
Evaluator Name
*
Department or Role
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
System Assessment
Facility Area Evaluated
*
Maternity Ward
Nursery
NICU
Pediatric Unit
Other
Overall System Effectiveness
*
1
2
3
4
5
Ease of Use and Staff Workflow Fit
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Security Features Review
Security features evaluation
*
Rows
Pass
Needs improvement
Not observed
Infant tagging and wristband reliability
1
2
3
Alarm response performance
4
5
6
Access control effectiveness
7
8
9
Exit monitoring coverage
10
11
12
Audit log visibility
13
14
15
Checklist items observed
Infant tagging/wristband checks
Alarm activation and response
Door/access control checks
Exit/egress monitoring checks
Audit log review
Other
Comments on security features
Observations and Recommendation
Key Observations
*
Overall Recommendation
*
Continue as-is
Improve with changes
Requires review
Not applicable
Submit Evaluation
Should be Empty: