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  • Conducted on

  • Prepared by

  • Location
  • This checklist is derived from the Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19 by the Centers for Disease Control and Prevention (CDC).
    https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp-preparedness-checklist.pdf

Review

  • Review your infection prevention and control policies and CDC infection control recommendations for COVID-19 for:

  • Assessment and triage of patients with acute respiratory symptoms

  • Patient placement

  • Implementation of Standard, Contact, and Airborne Precautions, including the use of eye protection

  • Visitor management and exclusion

  • Source control measures for patients (e.g., put facemask on suspect patients)

  • Requirements for performing aerosol generating procedures

  • Be alert for patients who meet the persons under investigation (PUI) definition

  • Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.

  • Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed coronavirus disease 2019 patient.

  • Remain at home, and notify occupational health services, if you are ill.

  • Know how to contact and receive information from your state or local public health agency.

Sign-off

  • Comments/Recommendations

  • Name & Signature

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