Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • General appearance of area is clean and orderly.

  • Trash bins are clean and not overfilled

  • Bio hazardous waste disposed of appropriately

  • Ceiling tiles are not stained or wet.

  • Air vents and overhead lenses are clean and free of dust and debris

  • Support closets are clean (electrical, telecom, etc.)

  • Furniture is in working order with no breaks in the fabric or material.

  • Under sink areas are clean and free of storage of equipment/supplies

  • Sharps containers are available at point of use and replaced before 3/4 full

  • Sharps containers are safely mounted/stabilized

  • Linen is covered, including on portable carts. If linen is stored in a dedicated room, cover not required.

  • Clean linen cart has solid surface on bottom shelf.

  • Soiled linens are discarded appropriately

  • Patient equipment is clean

  • Employees are aware of procedure for cleaning equipment using hospital approved disinfectant.

  • Employees are aware of the disinfectant contact time according to the manufacturer's instructions

  • PPE is available and staff is aware of location & appropriate use

  • PPE is worn appropriately in Isolation Rooms

  • Hand sanitizer, soap & paper towel dispensers are filled and have not expired

  • Appropriate hand hygiene observed (3 observations)

  • Sinks and/or hand sanitizer are available and appropriately placed

  • Isolation/precaution signs are appropriately placed

  • Only hospital-approved products are present (hand soap and sanitizes, lotions, cleaning products, etc.)

  • Only disposable equipment/instruments are used at the site, i.e. autoclaves & high level disinfection are not used.

  • Medical supplies have not expired

  • Medications and sharps are stored appropriately.

  • Clean and sterile supplies stored appropriately

  • Soiled and Clean Utility rooms are appropriate/ clean and dirty areas are separated.

  • Ice Machines are clean

  • Ice scoop is stored appropriately (not with ice)

  • Daily logs maintained (refrigerator, freezer, hydrocollator, etc.).

  • Only patient food is stored in patent fridge, and the food is not expired.

  • Food & drink is located in break rooms & not in patient care areas.

  • Microwaves, refrigerators and freezers are clean.

  • Other

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.