Audit

Personal Protective Equipment

Perform Hand Hygiene?

Corrective Action

Correct glove use?

Corrective Action

Gown and Mask? (If applicable)

Corrective Action

High Traffic/ High Touch Areas Areas

Door Knobs and Handles?

Corrective Action

Door Surface?

Corrective Action

Hand washing station/Sink Area?

Corrective Action

Counter Tops?

Corrective Action

Light Switches?

Corrective Action

Chairs and Furniture?

Corrective Action

Medical Equipment?

Corrective Action

TV, Stands. Remote, Electronics. ?

Corrective Action

Spot Clean Walls? (If Applicable)

Corrective Action

Cabinet Doors and Handles?

Corrective Action

Entire Hospital Bed Frame?

Corrective Action

Supply tray/Mayo Stand?

Corrective Action

Empty Trash and Replace Liner?

Corrective Action

Restrooms, IP Bathrooms, and/or Special Bathing (Only one area needs to be observed)

Door and Door knob/handle?

Corrective Action

Toilet Seat? (Horizontal Surface)

Corrective Action

Toilet Flush Lever?

Corrective Action

Sinks and Faucets?

Corrective Action

Hand rails? (If applicable)

Corrective Action

Tub or Shower? (If applicable)

Corrective Action

Mirrors?

Corrective Action

Floors

Wet mop entire floor?

Corrective Action

Post Cleaning

Change dust/mop pad?

Corrective Action

Properly Remove PPE?

Corrective Action

Perform correct hand hygiene?

Corrective Action

Room(s) appear presentable and clean?

Corrective Action

Conclusion

Please confirm time and date

By entering name, this acts as an electronic signature. Auditor please type name.

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.