Title Page

  • Audit Title

  • Conducted on

  • Inspected By

  • Location
  • Entrance to Area/Division Clean and Presentable? (Overall First Impression of area/unit)?<br>

  • Disinfection wipe container lids closed and labeled correctly? Chemical Dispensing unit in working condition?

  • Eye Wash sheets properly dated? (Unblocked)

  • Hopper rooms clean and in order? (No unnecessary items)

  • Housekeeping carts clean and free of unnecessary item?

  • Equipment clean? (Vacuums, buffers & carts)

  • Staff have knowledge of R.A.C.E. (Rescue Alarm Contain Extinguish) and P.A.S.S. (Pull Aim Squeeze Sweep.)?

  • Staff have knowledge of Dwell time for Disinfectant? (Name of Disinfectant)

  • UniQuat?

  • Performex?

  • Clorox Hydrogen Peroxide?

  • Does staff have knowledge of SDS? What is SDS? (Safety Data Sheets) Where is the SDS information located?

  • P.P.E. Available? (Gloves, Goggles is there evidence of use?)

  • Staff have knowledge of location of Fire Pull Stations?

  • Soiled Utility rooms cleaned & organized?

  • Green Trash & Red Bio Hazard carts cleaned & lined? (McClure Carts)

  • Hand Hygiene Being Performed? (Observation of Evidence)

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