Audit

A. Medication Rooms/Treatment Room:

1. Refrigerator temperature is between 36-46 degrees F and no items other than medication are present.

2. Items are not stored under the sink.

3. Hand washing sign is over the sink.

4. Hand washing or waterless agent is available

5. Paper towels are available in the dispenser.

6. There are no capped needle containers

7. Counter tops are clean.

8. Cabinets are clean.

9. Floor is clean.

10. No stained or missing ceiling tiles

11. Items are stored 4 inches above floor or moveable.

Additional Comments:

Nurses Station

1. Barrier kit easily accessible.

2. Staff knows how to access the Infection Prevention and Control Policy and Attachments.

3. Floor of nurse’s station is clean.

4. Countertops are clean and free of clutter.

5. Shelves are clean and free of clutter.

6. There are no dirty dishes on desks and counters of nurse’s station.

7.True Exposure Protocol Packet available.

8. No stained or missing ceiling tiles.

9. Items are stored 4 inches above floor or moveable.

Additional Comments:

C. Hallways/Other Individual Care Areas

1. Dirty linen containers are located outside door of unit or in soiled holding area on the unit.

15. No stained or missing ceiling tiles.

2. Clean linens are stored neatly on the shelves of the clean linen closets and linen is covered with plastic wrap.

3. There are no dirty dishes/trays in the hallway.

4. Hallway floors are clean and free of clutter.

5. Sharps containers are secured and less than 2/3 full.

6. Dayroom floors are clean and
free of clutter.

7. Curtains and upholstery are clean and in good repair.

8. Surfaces in dayroom are clean.

9. Refrigerator temperature is between 35 and 46 degrees F and all food is covered and dated.

10. Sinks are clean.

11. Scoops for ice are stored inside the icemaker/machine or inside a scoop holder which may be mounted outside of the machine.

12. Trashcans are emptied regularly and are free of odor.

13. Floors are clean.

14. Mop water clean/changed properly. Note: The mop water and mop head will be changed at least every three (3) rooms, after mopping each bathroom or each contaminated area, and at least every hour.

16. Items are stored 4 inches above floor or moveable.

Additional Comments:

D. Individuals Rooms

1. Floor is clean and free of clutter.

2. Clean linen on beds.

3. Dirty clothes are in hamper.

4. Mattresses & pillows free of tears.

5. There is no food or drink in the room.

6. Vents are clean and in good repair.

7. Surfaces are clean and free of clutter.

8. Equipment/door is labeled in all dedicated rooms.

9. Bed side tables/night stands clean.

10. No stained or missing ceiling tiles

11. Items are stored 4 inches above floor or moveable.

Additional Comments:

E. Individuals Restrooms

1. An adequate supply of soap and paper towels is present.

2. Sink and counters are clean and free of clutter.

3. Personal Care Kit items are in personal containers and toothbrushes are stored with a cover.

4. Toilet is clean and free of odor.

5. Toilet paper is available in the holder.

6. Floors are clean and free of clutter.

7. Showers, shower chairs, tubs are clean and in good repair.

8. Shower curtains are clean and not torn.

9. Restrooms are free of dirty towels and clothes.

10. No stained or missing ceiling tiles

11. Items are stored 4 inches above floor or moveable.

Additional Comments:

F. Employee/Visitor Restrooms

1. Hand washing signs are posted.

2. An adequate supply of soap and paper towels is present.

3. Sink and counter tops are clean and free of clutter.

4. Toilet is clean and free of odor.

5. Floors are clean.

6. Trash cans are emptied.

7. No stained or missing ceiling tiles

8. Items are stored 4 inches above floor or moveable.

Additional Comments:

G. Dining Room

1. The dining tables and chairs are clean.

2. The Inspection Report is posted.

3. All food is labeled.

4. All dated food is within recommended use/expiration date.

5. Refrigerator temperature is 40 degrees F or below.

6. Dining room is clean and free of clutter.

7. Refrigerator, dishwasher water and food temperatures are recorded.

8. Personal Protective Equipment (PPE) in dining area.

9. No stained or missing ceiling tiles.

10. Items are stored 4 inches above floor or moveable.

Additional Comments:

H. Support Areas

1. Work area is clean, neat and free of clutter.

2. Staff knows how to access electronic manuals.

3. Hand washing facilities are available with adequate soap, paper towels & waterless gel.

4. No stained or missing ceiling tiles

5. Items are stored 4 inches above floor or moveable.

Additional Comments:

I. Barber/Beautician Areas

1. Work area is clean, neat and free of clutter.

2. Hand washing facilities are available with adequate soap, paper towels, & waterless gel.

3. Disposable razor blades and other sharps are discarded in secured, impervious container less than 2/3 full.

4. Soiled linen container is covered

5. No stained or missing ceiling tiles.

6. Items are stored 4 inches above floor or moveable.

Additional Comments:

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.