Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Did the Admissions representative ask about travel upon hearing the symptoms?

  • Was a mask, gloves, and emesis bag offered to the patient?

  • Was the call made to the triage nurse?

  • Did they wipe down the counter and call housekeeping to clean area of travel?

  • Did triage nurse come dressed in basic PPE?

  • Did the triage nurse make contact with the patient?

  • Did the nurse follow the pre-designated route for ebola patient?

  • Did the nurse enter the patient room?

  • Was physician notified immediately?

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