Hand Hygiene

• Employee Name

• EID #

• Facility

  Broadway

  SMCF

  South University

• room number or location

• Date

  Date

• Observer

Hand Hygiene

• HH on entry of room

  Yes

  No

  N/A

• Type of hand hygiene

  Alcohol based

  Soap & water

  N/A

• HH between dirty and clean tasks

  Yes

  No

  N/A

• Proper glove changes

  Yes

  No

  N/A

• HH on exit of room

  Yes

  No

  N/A

• Type of hand hygiene

  Alcohol based

  Soap & water

  N/A

General Comments

• undefined