Wound Progress Assessment Form

Based on TIME framework and periwound assessment

Basic Information

Wound Number

Patient Name

IC / Identification Number

Date of Dressing

Next Appointment Date

Vital Signs

Blood Pressure (mmHg)

Pulse (bpm)

SpO₂ (%)

Temperature (°C)

Random Blood Sugar (mmol/L)

Pain Scale (1–10)

Wound Size

Length (cm)

Width (cm)

Depth (cm)

(T) Tissue Viability

Estimate percentage of each tissue type within the wound bed.

Slough (%)

Necrotic (%)

Red Granulation (%)

Pink Epithelial (%)

Tissue Viability Description

(I) Infection / Inflammation

Tick all relevant signs present.

Infection / Inflammation Description

(M) Moisture Imbalance

Select the closest description of wound moisture.

Dry Wet – minimal exudate Wet – moderate exudate Wet – heavy exudate

(E) Edges / Epidermal Margin

Describe any rolled edges (epibole), maceration, undermining, desiccation, etc.

Edges description

Wound Type & Periwound Skin

Wound Type (1–8)

Periwound Skin Classification

Treatment & Interventions

Cleansing Solution

Dressing Material

Debridement Method

Culture Taken (Date / Organism)

Type of Antibiotic

Health Education (Specify)

Staff & Notes

Dressing Performed By

Documentation By

Remarks / Comments

Signature / Stamp (Name & designation)

Generated Documentation (English)