Number of Physician

Number of Nurses

Number of PCA

Number of House Keepers

Number of Porters

Number of Clerks


Other Workers


General Hospital policies in place & available

Nursing policy manual

Unit/area specific manual

Unit/area specific policy manual

Nursing policy manual

Staff Orientation manual

Infection Control manual

Equipment/Service Manual

Procedural Guidelines

Clinical practice guidelines

Occupational Health and Safety Guidelines

Infection Prevention & control guidelines

Do managers, supervisors and employees have a clear understanding of their roles and responsibilities

Is there evidence of compliance with statutory requirement


Is there communication procedure/protocol

Are employees knowledgeable about health and safety management

Are managers aware of Heath of the heath and safety role and responsibilites

Are relevant health and safety policies and procedures communicated to employees

Are policies and procedures manual easily accessible at the workplace

Is there a policy and procedure in place for reporting incidents and near mises

Are incidents/accidents written as per policy


Is safety and health training made available for all employees

Are all employees aware pf their duies to attend safety and health training

Is non attendance at training programmes recorded/managed

Do employees understand the limitations and use of PPE

Is training programmes in place

Is there a system for flagging refresher training

Is refresher training provided

Is there a formal orientation programme for new employees

Is health and safety adequately addressed in the orientation programme

Are employees given instruction, training and supervision in a form, manner and as appropriate, language that is likely to be understood by the employee

Is instruction, training and supervision provided to employees in recruitment, transfer, change task, on new equipment, new tehnology etc.


Blood, bodily fluid exposure management posted

Hazardous chemical: labels and MSDSs

Restricted area

Fire exits

Evacuation routes

Isolation signs

Wet Floor

Eye wash stations (e.g. lab, chemical storage areas)

Instruction for use of Personal Protective Equipment

Noise protection required

Bio-hazard areas

Radiation area

Hand Hygiene posters


Written bio-hazardous waste protocol present

Written regular waste disposal protocol present

Appropriately label containers/bag for waste

Waste facility in good condition

Waste segregation adhere to


Contact for security posted

Emergency number for internal and external contacts are available

Visitors/Contractors rules in place



There is an active IPC Committee at the hospital {meeting and action items evident}

The committee meets at least every 2 months

The Health Facility's Infection Control Policies and Procedures Manual is readily available in the Nursery

Staff of the Nursery of the Nursery are aware of the key concepts contained in the manual

The ward sister/charge nurse/team leader is aware of their role and responsibility in relation to infection prevention and control (IPC)

Within the Nursery, there is a lead person responsible for IPC

There is evidence of a multi-professional approach to IPC {meetings & Minutes}

There is evidence that at least one (1) Audit on IPC practices has been conducted in the nursery within the last 12 months

There is evidence of improvements in keeping with corrective action schedule from the last audit

IPC nurse conduct daily visits to the neonatal nursery

Incidents related to IPC are reported immediately to IPC committee and Hospital Directorate immediately

There is evidence that outbreak of an infection or increased incidence of an infection is reported to the surveillance Unit of the Ministry of Health within 24 hours

There is evidence that incidents related to infection prevention and control are actioned appropriately


There is adequate Eqiupment and Supplies for hand hygiene

Soft absorbent paper towels are available at all hand washing sinks

Soap available in dispensers

Adequate Hot water available

Adequate cold water availble

Sinks clean and well maintained

Wash hand sinks present in dirty utility room

Sinks present in clean room

Clean and dirty sink identified

Hand sanitizer dispenser clean & good working order

Soap dispenser in clean & good working order


Proper Management of Soil or contaminated linen


Proper storage


Date and time of used medication

Safe Injection Practices

Suitable Personal Protective Equipment; Adequate Supplies of:

N95 respirator in adequate amount

Protective eyewear

Impermeable gowns

Workers trained in PPE

PPE available and worn when necessary

Disposable gowns

Shoe coverings

Surgical Masks


Furniture in good condition

Refrigerator temperature recorded & Maintained

Personal Items neatly placed

Nurses station clean and tidy

Isolation room appropriately ventilated

Is there patient call system in the unit/functional

Are patient aware of the system

Does staff respond to alarms/buzzers

Broken beds, stretchers, Wheel Chair/tables/lockers/mattresses

Handrails/grab bars in bathroom

non skid tiles/bath boards in shower

Are patient aware of the system

Equipment Procedure

Autoclave clean & in good working condition

Frequent Microbiological testing

Microwave clean & in good working order

Glucometer, oximeters, monitoring equipment clean

Patient lift available, maintained & clean

Bedpan flusher/sterilizers clean and in good working condition

Oxygen Cylinder storage appropriate

Cleaning procedure appropriate

Guarding safety device in place

Start/stop switches clearly marked and easy to reach

Safe operating procedure available

Lockout procedure available

Training given in safe use of tools and machinery

Manufacturer's manuals available for all tools and machinery


Schedule cleaning for water storage tank

Residual chlorine present in tap water

Plumbing Fixture

Air Conditioning unit


Suitable ergonomics chairs available

Foot rest provided for desk

Countertops & Work station at appropriate height & adjustable

Ergonomic lifting device available

Store heavy items at waste height

Sharps Handling

Sharps disposal at point-of-use

Sharps container not overfilled(2/3)

Sharps container appropriate

Safety Engineered needles available

Sharps containers elevated

ENVIRONMENTAL HEALTH - Physical Environment

Floor slip-proof

Floor, walls doors, and ceiling clean & intact

Floor & doorway clear and free of obstructions

Good drainage for spills

Changes in floor level clearly marked

No mold or fungus

No cords on floors & other tripping hazards

Shelves present and adequate to support material

Steps and rails adequate

Ramps for disable present


Lighting adequate, maintained

Task specific lighting present where appropriate

Natural lighting adequate

Emergency lighting provided and Maintained

Electrical outlets well located

Outlets sufficient to avoid overloading


Minimum 15 total air changes per

Minimum 3 air changes of outdoor
air per hour

Negative pressure in Isolation areas, autopsy suite

Positive pressure in operating room

Mechanical ventilation for hazardous emissions such as sterilizing chemicals

Temperature Satisfactory

Relative Humidity Satisfactory

CO2 satisfactory

Exhaust Fume Hood

Physical integrity satisfactory

Signs of blockage

Unusual Noise


Type of Filters satisfactory

Filter efficiency satisfactory

Filter clean

Signs of by passing

Change out schedule

Duct Work

Physical integrity satisfactory

Dryness & Cleanliness satisfactory

Signs of blockage from static pressure

Air balancing records

Reheat Coils/Mixing Boxes

Dryness & Cleanliness Satisfactory

VAV(Variable air volume) calibration set for at least minimum

Required outside air delivery at all times

HVAC Equipment( e.g. Heating/cooling units, stacks and condensers)

Physical integrity

Dryness & Cleanliness satisfactory

No slime, mold, dirt bird dropping, soot accumulation

Integrity & cleanliness of chamber floor, wall and ceiling

Cleanliness & operation of various components satisfactory


Type & Location appropriate

Set appropriately

Access controlled


Emergency exits visible

Emergency exit free from obstruction

Emergency evacuation plan posted

Fire extinguishers present

Fire extinguishes regularly inspected

Fire Protection equipment (e.g hoses) accessible & maintained

Clear access to electrical panels/no combustible material stored

Sockets in good condition

Staff Areas: Clean and Orderly Appearance, enough room to work

Staff lockers/change area accessible and available

Staff lounge present & clean with no medical supplies or device

Staff toilet clean

Refrigerator in good working orde

Furniture/office equipment secure from tripping: appropriate work being done

Treatment room

Equipment storage

Chemical storage

Staff Areas

Work areas(e.g.lab benches, maintenance rooms

Containers with proper lids

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.