Title Page

  • Site conducted

  • Conducted on

  • Interviewee


Interview questions

  • Q1 Did you receive orientation, buddying, and training when you first started?

  • Q1 Comments

  • Q2 Do you have written procedures available to you?

  • Q3 Are expectations for your role clear?

  • Q3 comments

  • Q4 What happens if not all tasks are completed by the end of your shift?

  • Q5 For infection control patients with signage on their doors, do you know how to complete cleaning safely without spreading infection?

  • Q6 During an infection outbreak, such as Gastro, are you included in communication and receive all the support you need?

  • Q7 Is there a protocol for cleaning up blood and body fluids?

  • Q7 explanation

  • Q8 Are issues/problems, incidents and hazards dealt with?

  • Q9 Do you feel comfortable raising issues?

  • Q10 Have you raised any recently and what was the outcome?

Compliance questions

  • Cleaner communicated with patients when entering a room

  • SOPs performed in right order, mechanical clean then chemical disinfection.

  • Frequent touch areas are cleaned often

  • Cleaning chemicals match list, and disinfectant used correctly

  • All intended areas were cleaned, and no areas appear dirty

  • Cleaner follows transmission-based precautions

  • Cleans area in defined zones meeting criteria of policy

  • Area cleaned from high to low

  • Area cleaned from clean to dirty

  • Equipment and solutions are changed between zones.

  • Equipment is cleaned before leaving infectious rooms.

  • Equipment is colour coded.

  • Cleaner has a pager and can be contacted for urgent assistance

  • Chemical safety data sheets are displayed

  • Cleaning equipment is regularly replaced

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.