• The name of key contact person (such as a supervisor or scheduler) who can assist the surveyor(s) in
planning tracer selection
• A list of contact telephone numbers in case the surveyor(s) needs to reach key staff
• A list of all employees (providing direct and indirect patient care), with name, date of hire, job title,
and primary location of work in the hospital
• A list of all independent clinical practitioners (physicians and others, such as dentists, psychologists,
and others) privileged by the medical staff, with the name, clinical department or specialty and date of
appointment or reappointment to the medical staff
• A list of measures from the Joint Commission International Library of Measures (see page 129)
selected
• A list of clinical guidelines, pathways, or protocols selected
• A sample of the forms used in the medical record
• Copies of the Strategic Improvement Plans (SIP) submitted to the JCI Central Office
• A list of approved/unapproved abbreviations (one list for each surveyor)
• A list of students/trainees assigned to the hospital and their associated academic program