Newborn Home Visit Nursing Checklist
Date of Visit
Nurse Name
Family Name
Baby Name
Date of Birth
Age (days/weeks)
1. Preliminary Information
Review maternal and newborn health records
Confirm birth details and contact information
2. Assessment
Vital signs (temperature, heart rate, respiration)
General appearance and behavior
Weight and jaundice check
Umbilical cord assessment
Skin condition
Feeding assessment
Urine and stool output
Screen for danger signs
3. Maternal Assessment
General wellbeing
Breast health and feeding support
Screen for postpartum complications
4. Counseling & Education
Safe sleep environment
Immunizations schedule
Hygiene and cord care
Family planning
Danger signs (mother & baby)
Follow-up visit instructions
5. Referrals / Follow-up
Referral to health facility if needed
Schedule next visit
Notes