Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Cleanliness and Storage
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Refrigerators clean
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Refrigerators have current temperature log?
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Food and drinks in refrigerator/freezer labeled appropriately?
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No expired foods/drinks?
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Patient/employee food/drinks in separate refrigerators?
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Nutrition room clean/orderly with no expired items?
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Ice makers clean?
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Ceiling tile without holes or stains?
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Negative airflow log up to date?
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Are there any torn furniture or rusty/dusty equipment?
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Are floors clean?
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Are sharps containers less than 3/4th full?
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Are items stored under sinks?
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Are cleaners approved and are there MSDS sheets available?
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Are staff able to verbalize contact (kill) time for each cleaner they are using?
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Are air vents clean in all locations observed?
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Are shower curtains clean and free from mildew?
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Are bed frames clean and free from dust including under the mattress?
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Is the dirty utility room clean?
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Are ice chests/buckets clean and are ice scoops stored appropriate so as to prevent contamination?
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Is clean and dirty linen stored separately and covered?
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If hand hygiene observation opportunity occurred, was the observed staff compliant?
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Were staff able to verbalize location of Infection Prevention policies?
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Was staff able to verbalize the location of PPE on their unit?
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Was staff able to verbalize procedure for notification of infectious diseases to Infection Control department?
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Was staff able to verbalize Infection Control education opportunities?
