Title Page

  • Prepared by

  • Location


  • Number of Patients on Isolation?

  • Any new patients?

  • MDRO scoring correctly done for all new cases?

  • Visual triage correctly done for all new patients?

  • Availability of essential items in the areas (IC related items)

  • Any noncompliance of IC practices monitored?

  • If yes, mention action taken?

  • Any new IC non approved items available in the area?

  • If yes, Specify?

  • Documentation and isolations orders are placed on time as required

  • Bundle of care implemented as documented (check random patients)

  • Any new/rare organism with any patients reported or same organism with more than one patient reported

  • If yes, specify. follow outbreak management protocol

  • Waste management implemented and followed as per policy

  • Discussed all concerns with head nurse/charge nurse

  • Questions or concerns received from your area Please mention the concern and action taken

  • If long term issue, mention the time frame to close and the responsible person

  • Other comments?

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