CHCO at MHHand Hygiene Monitoring Tool

• Location & Unit

• Conducted on

  Date

• Select date

  Date

• Observer

Hand Hygiene

Hand Hygiene

• Healthcare Provider Type

  Select Physician Nurse PNP/NNP/PA RT CA/MA/CMT/PCT Student OT/PT ES/EVS XRay Tech Phlebotomist Volunteer Dietary Other

  • Physician
  • Nurse
  • PNP/NNP/PA
  • RT
  • CA/MA/CMT/PCT
  • Student
  • OT/PT
  • ES/EVS
  • XRay Tech
  • Phlebotomist
  • Volunteer
  • Dietary
  • Other

• Hand Hygiene Upon Entering Room

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Hand Hygiene Upon Exiting Room

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Comments: