Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

EMPLOYEE INTERVIEW

  • Staff can verbalise where the infection control manual is

  • Staff can verbalise steps to take if an injury or exposure occurs

  • Staff can locate infection control and employee health contact numbers

  • Staff can locate nearest spill kit

  • Staff can name and use of appropriate disinfectant and its contact time

EQUIPMENT / SUPPLIES

  • Linen is covered and stored appropriately <br>

  • Expired supplies found gg

  • Accu-checks are cleaned and stored appropriately

  • Refrigerators are clean and well kept

  • Furniture and equipment is in good working condition and able to be disinfected

  • Equipment is not stored on the floor

  • Clean and dirty supplies are clearly marked and stored in different locations

  • No under sink storagw

EVS

  • Vents are clear of dust and debris

  • Floors are clear of trash and any fluid

  • Furniture, equipment, ledges and high areas are free of dust

  • The department is clear of any and all pests

  • Waste is discarded in appropriate container

  • Waste receptacles are not overflowing

  • Curtains are clean and stain/door cree

  • Hand washing sink and/or hand disinfectant available for staff use

  • Soap, alcohol gel and paper towels are stocked and working properly

  • Contact time is being followed for the appropriate disinfectant.

GENERAL

  • Expired food and drink found in department

  • Hand hygiene is bing performed during the appropriate time

  • Food and drinks are found only in appropriate areas

HAZARDOUS MATERIALS

  • Sharp containers are secured and not more than 3/4 full

  • Chemicals are labeled and stored appropriately

  • Biohazard containers are appropriately labeled

ISOLATION

  • Appropriate sign is posted

  • Isolation cart is available and stocked

  • PPE is being used appropriately by staff members

  • Bleach wipes are available for C Diff isolation rooms

MEDICATION

  • Medications are secured

  • Expired medications are found

  • Pill crushers and slicers are clean and sanitary

  • Hand hygiene is being performed during med pass

TEMPERATURE AND HUMIDITY

  • Temperature and humidity is logged daily for current month

  • Temperature and humidity are within the normal or stated ranged for current month

  • If no, was an appropriate action documented

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.