Inspection

Hand Hygiene Audit

List the healthcare workers to be observed by tapping ADD HEALTHCARE WORKER.

Healthcare Worker

Name of Healthcare Worker (optional)

Select healthcare worker category.

Please specify.

Ward/ Unit/ Department

The Five Moments of Hand Hygiene

Before patient contact

Before an aseptic prodecure

After body fluid exposure

After patient contact

After contact with patient surroundings

Completion

Overall Recommendations

Full Name and Signature of Auditor
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.