Spotlight on Prevention: Best Practices for Body Checks Spotlight on Prevention: Best Practices for Body Checks
www.justicecenter.gov
www.justicecenter.ny.gov Possible cause of mark or injury?
Were marks or injuries noted on previous body check? Y or N Date of previous body check: _________________________
Comments? __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________
Injury above the neck? Y or N If yes, was Head Injury Protocol started? Y or N
RN notification of marks or injuries? Y or N Person notified (print clearly): _________________________ Date/Time notified: __________________________________ Notified by (print clearly):_____________________________ Manager/Supervisor notification of marks or injuries? Y or N Person notified (print clearly): __________________________ Date/Time notified: ___________________________________ Notified by (print clearly): ______________________________ Family notified of marks or injuries? Y or N Person notified (print clearly): ___________________________ Date/Time notified: ____________________________________ Notified by (print clearly): _______________________________
Photos taken? Y or N Note: Only agency issued equipment to be used for taking photos.
Findings noted in Communication Log? Y or N
RN Review/Findings: ______________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ RN (print): ________________________ Sign: _______________________ Date: _____________ Manager Review/Findings: _________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Manager (print): ________________________ Sign: ___________________ Date: _____________
Staff (print): ____________________________ Sign: ___________________ Date: _____________ Witness (print): _________________________ Sign: ___________________ Date: _____________
23
Made with FlippingBook - PDF hosting