Facility & Equipment/supplies Form - Basic Nursing Assistant Training Program
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1BASIC NURSING ASSISTANT TRAINING PROGRAM
FACILITY & EQUIPMENT/SUPPLIES FORM
This form is being completed as part of a New BNATP application and will be attached to the
BNATP NEW PROGRAM SUBMISSION CHECKLIST.
This form is being completed and will be attached to the BNATP COMPLICANCE VERIFICATION
SUBMISSION CHECKLIST.
This form is being submitted because of proposed changes in a theory and/or lab location of an
existing BNATP.
Please answer the following questions and provide the requested information regarding Theory and Lab
Attach additional pages as
Environment, including the BUILDING in which class is to be conducted.
necessary to provide all requested information.
Are other businesses located in the same building? ________
•
If so, please list and provide a description of these.
•
What is the maximum number of students you plan to have in each class? _______________
•
Is and how many hand washing sink(s) are available in the theory classroom? __________
•
Is and how many hand washing sink(s) are available in the lab? __________
•
How many of the theory hours will be designated/used for lab? _________________
•
Is the lab environment a dedicated space? ________________________
•
Describe other uses for the lab space.
•
THEORY and LABORATORY PHYSICAL ENVIRONMENT(S)
Type of Space
Room
Total Net
Total
Type of seating for
AV &/or Multi-Media Equipment
(Classroom or
Number
Square Feet
Seating
students (desk,
Available
Lab)
Capacity
chair, table?)
Indicate the number/amount of the following equipment and supplies that are available for use by
students in theory and/or lab at this location. Since this is only a partial listing, include additional
equipment and supplies available for your students.
ITEM
NUMBER and/or AMOUNT
Hospital beds (1 bed per 5 students)
Bed linen – be specific
Pillows
Overbed tables, bedside cabinets, chairs
Stethoscopes (include training stethoscopes)
Thermometers (indicate the types)
Sphygmomanometers (indicate available sizes)
Bedpans, urinals, emesis basins, wash basins
Wheelchairs
Transfer/gait belts
LIST other necessary equipment/supplies
BNATP Sponsor ________________________________________
BNAT Program Code ________
Date ____________________
03.2014
Date _____________________
03.2014
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