Title Page

  • Site conducted

  • Facility

  • Location
  • Name of Auditor

  • Date of Audit

Hand Hygiene Audit

  • Is the patient on Isolation Precautions?

  • Is notification visible outside of room?

  • Healthcare Worker
  • Select healthcare worker category.

  • 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


  • Overall Recommendations

  • Full Name and Signature of Auditor

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.