職安衛人員經常使用評估表來協助作業，因此如何設計符合需求之表單極為重要，此外因為涉及之作業較為複雜及重覆，將操作流程及相關文件一致及書面化有助於協助作業同時避免失誤。本文旨在報告某醫院職安衛人員，參考評估表板模開發及標準作業文件撰寫之相關文獻，於2014年發展職場母性健康保護評估表模板設計與管理計畫的實務經驗，希望能作為其它職場規劃之參考。

Checklists were usually applied to help occupational safety and health professionals to assist their complex and repetitive jobs. Thus it is important to prepare a standard operating procedure and design a template to meet the needs and to help avoid mistakes or errors. The aim of this report is to present our practice experience of the implementation of maternity protection in the workplace at hospital facilities since 2014, in particular emphasizing procedures and tools employed from related articles. We hope that our experience can contribute to write a management plan in other workplace situations.