Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Cleanliness and Storage

  • Refrigerators clean

  • Refrigerators have current temperature log?

  • Food and drinks in refrigerator/freezer labeled appropriately?

  • No expired foods/drinks?

  • Patient/employee food/drinks in separate refrigerators?

  • Nutrition room clean/orderly with no expired items?

  • Ice makers clean?

  • Ceiling tile without holes or stains?

  • Negative airflow log up to date?

  • Are there any torn furniture or rusty/dusty equipment?

  • Are floors clean?

  • Are sharps containers less than 3/4th full?

  • Are items stored under sinks?

  • Are cleaners approved and are there MSDS sheets available?

  • Are staff able to verbalize contact (kill) time for each cleaner they are using?

  • Are air vents clean in all locations observed?

  • Are shower curtains clean and free from mildew?

  • Are bed frames clean and free from dust including under the mattress?

  • Is the dirty utility room clean?

  • Are ice chests/buckets clean and are ice scoops stored appropriate so as to prevent contamination?

  • Is clean and dirty linen stored separately and covered?

  • If hand hygiene observation opportunity occurred, was the observed staff compliant?

  • Were staff able to verbalize location of Infection Prevention policies?

  • Was staff able to verbalize the location of PPE on their unit?

  • Was staff able to verbalize procedure for notification of infectious diseases to Infection Control department?

  • Was staff able to verbalize Infection Control education opportunities?

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