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

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