UCSD Health Sciences - Compliance / Privacy Programs
Checklist for Departments: Observers in Clinical Settings
Observer’s Name___________________ Training Date
Department / Work Area _____________ Sponsor’s Name: _______________
Instructions: The purpose of the observer(s) visit should be in keeping with UCSD’s mission of patient
care, teaching, research and education; and not detrimental to UCSD Medical Center’s health care
operations. The faculty sponsor (or UCSDMC Leader) for the observer is responsible for ensuring that the
checklist requirements are satisfied. Please complete the checklist, discuss pertinent orientation topics.
Return the signed acknowledgment form to the Compliance / Privacy Office:
Tel: 619-471-9152; FAX: 619-471-9158; Mail Code: 0836
Indicate the purpose of the observer’s visit:
[___] Health care education; [___] Interested in health care career; [___] Other: ___________________
Unit Orientation: Conduct & ID Badge
- Code of Conduct & wear Visitor ID Badge
- Department Core Values Orientation.
- Charge Nurse /Manager / Assistant
- Use of Telephone / Fax / Copier use, if any
- General tour of unit & emergency exits
- Health Screening (neg.TB, current vaccn.)
- OIG Exclusion Screening (negative results)
- Expectations: Professional business conduct,
dress and appearance; adhere to privacy
- Who to report concerns to : _________
Patient Care Information
- Patient consent for the presence of
observers must be obtained by the
patient’s treating physician.
- Patients have a Right of Privacy
- Independent interacting with patients is not
permitted. Observers are not permitted
direct patient contact (hands-on care or
practice of medicine) and are to be
accompanied by a UCSDMC staff person at
all times.
- Do not enter patient rooms which are on
“airborne precautions” unless FIT-tested.
- Visitation policy, visiting hours
Safety Information
- UCSD Emergency Number 6111
- Department / Unit Security Measures
- Location of fire alarm on unit
- Location of fire pulls and extinguishers
- Code Red - Evacuation plan
- Code Blue Assignment
- Code 10 – Bomb Treat Procedure
- Code Triage Assignment
- Response to codes / alarms
Hospital Policies
- Practice of medicine is not permitted.
- Hands-on patient care / equipment is not
permitted.
- Access to information systems is not permitted.
- Do not access, use or disclose medical information
outside of the educational experience at UCSDMC.
- Personal photography, video-recordings, audiotaping of patients, staff or visitors or
photocopying medical information is not
permitted.
Health Screening & Infection Control
- Health statement documentation is completed and
on file in the department or COEM, including:
measles, mumps, rubella, chicken pox, negative TB
within the last 12 months. Refer to page 2, COEM
- Hand washing review
- Location of personal protective equipment
- Location of disposal containers
- Respiratory FIT tested for airborne precautions, if
applicable.
- http://health.ucsd.edu/specialties/occ/
Privacy / Security
- Patient protected health information (PHI) is any
information linked to an individual that relates to their
health care in any form (spoken, written, electronic).
- PHI is confidential, protected by State/Federal laws.
- Passwords & keys may not be given to observers.
- Unauthorized access, use or disclosure of
patient protected health information is a
violation of State / Federal privacy laws and
subject to disciplinary actions and possible legal
action. Privacy breaches are subject to fines.
I completed the Observer Checklist and reviewed the orientation / privacy training requirements with the
observer named above.
Sponsor’s Name:
Sponsor’s Signature / Date / Phone #:
Where can observers obtain TB Skin Testing?
Individuals who do not have proof of a current negative TB skin test (within the last 12-months), may
obtain the skin test through the UCSD Center for Occupational Environmental Medicine (COEM):
Approx cost: $18/TB skin test. Clinic Hours: 8:00 - 4:30, no appt necessary
Since the skin test must be read 3 days later, allow sufficient time to obtain the results before beginning a
clinical observer visit.
Refer to the web-link and locations below for additional information about UCSD COEM’s testing
locations and services or call 619-543-7060
http://health.ucsd.edu/specialties/occ/
COEM locations:
Center for Occupational & Environmental Medicine - Hillcrest
330 Lewis Street, Ste. 100
San Diego, CA 92103
619-471-9210
Center for Occupational & Environmental Medicine - UTC/La Jolla
8899 University Center Lane, Ste 160
San Diego, CA 92122
How does a host department obtain a visitor Identification (ID) Badge for the
observer?
The sponsor for authorized visitors is responsible for arranging for the temporary, non-photo ID badge with UCSD
Medical Center Security Office.

All UCSD Medical Center employees (including doctors, nurses, and all other staff) must wear a photo
identification (ID) badge in a prominent location.

Authorized visitors will be issued a non-photo identification badge which must be worn at all times while on
UCSD Health System premises.

Purpose: Badges allow on-site Security Agents to distinguish between employees and visitors, thereby
simplifying the responsibilities expected of them. Badges allow employees to distinguish visitors easily, and to be
especially sensitive to the customer service needs of the public, i.e., answering “way-finding” and other questions
as may arise.

The sponsoring department will complete form D565 (available from the intra-net site: http://forms.ucsd.edu ) and
route the completed and signed form the UCSD Medical Center Security Services Office in Hillcrest.
o For non-photo ID badges, the observer may obtain a temporary badge during the hours: 8:00 – 4:00,
Monday – Friday.
o The Observer Badge will identify: observer’s name and ‘observer title’, visitor’s host department name,
and the expiration date (typically 1 to 5-days).