Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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General appearance of area is clean and orderly.
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Trash bins are clean and not overfilled
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Bio hazardous waste disposed of appropriately
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Ceiling tiles are not stained or wet.
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Air vents and overhead lenses are clean and free of dust and debris
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Support closets are clean (electrical, telecom, etc.)
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Furniture is in working order with no breaks in the fabric or material.
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Under sink areas are clean and free of storage of equipment/supplies
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Sharps containers are available at point of use and replaced before 3/4 full
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Sharps containers are safely mounted/stabilized
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Linen is covered, including on portable carts. If linen is stored in a dedicated room, cover not required.
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Clean linen cart has solid surface on bottom shelf.
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Soiled linens are discarded appropriately
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Patient equipment is clean
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Employees are aware of procedure for cleaning equipment using hospital approved disinfectant.
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Employees are aware of the disinfectant contact time according to the manufacturer's instructions
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PPE is available and staff is aware of location & appropriate use
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PPE is worn appropriately in Isolation Rooms
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Hand sanitizer, soap & paper towel dispensers are filled and have not expired
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Appropriate hand hygiene observed (3 observations)
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Sinks and/or hand sanitizer are available and appropriately placed
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Isolation/precaution signs are appropriately placed
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Only hospital-approved products are present (hand soap and sanitizes, lotions, cleaning products, etc.)
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Only disposable equipment/instruments are used at the site, i.e. autoclaves & high level disinfection are not used.
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Medical supplies have not expired
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Medications and sharps are stored appropriately.
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Clean and sterile supplies stored appropriately
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Soiled and Clean Utility rooms are appropriate/ clean and dirty areas are separated.
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Ice Machines are clean
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Ice scoop is stored appropriately (not with ice)
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Daily logs maintained (refrigerator, freezer, hydrocollator, etc.).
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Only patient food is stored in patent fridge, and the food is not expired.
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Food & drink is located in break rooms & not in patient care areas.
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Microwaves, refrigerators and freezers are clean.
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Other