The assessors believe the information contained within this risk assessment report to be correct at the time of printing. The assessors do not accept responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the assessors during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made.
Confidentiality Statement

In order to maintain the integrity and credibility of the risk assessment processes and to protect the parties involved, it is understood that the assessors will not divulge to unauthorized persons any information obtained during this risk assessment unless legally obligated to do so.


Personal Protective Equipment (PPE) availability


Please choose which gloves are available

Isolation Gown

Face Shield / Goggles

Surgical Mask

N95 Mask

Please choose which N95 Mask is available
Hand Hygiene Program

Alcohol Based Hand Rub Dispensers filled up

Alcohol Based Hand Rub Bottle available

Soap Dispenser filled up

Paper Towels available

Isolation Practices

Sign Precaution Hanged outside isolation room / or on curtain in case of cohorting

PPE kept outside isolation room / or beside bed in case of cohorting

Staff Compliance to Standard Precaution Practices

Isolation log book available

Medical Waste Segregation

No overfilling observed

No mixing disposal

No recapped needles

All containers kept clean


Double Buckets for Regular room available

Double Buckets for isolation room available

Double Buckets Containers kept clean

Is the area kept clean and no visible soil or dirt all horizontal and vertical surfaces (Please explain in the note down in case if non-compliant)

Is cleaning schedule available?

Environmental Disinfectant

Spray Disinfectant available (Please write the name of Disinfectant in the note down)

Floor Disinfectant available (Please write the name of Disinfectant in the note down)

Name of Audit Surveyor
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.