Infection Control Policies:

Are updated Infection Control policies reviewed and communicated to everyone?

Are copies of the manual accessible to team members in all units?

Has IPAC manual been reviewed annually in collaboration with JH&S Commitee?

IPAC Program & Committee

Is there a separate agenda and minutes?

Is there a dedicated IPAC bulletin/ visual display board? are the information up to date?

Is the IPAC inspection protocol completed at least annually?

Are there trained respirator fit testers available?

Are all team members N95 Fit tested at hire and every 2 years?

Are there at least 3 days of outbreak supply (PPE, Sanitizer and etc.) available?

Is there a designated staff member to co-ordinate the infection prevention and control program with education and experience in infection prevention and control practices including: (a) infectious disease (b) cleaning and disinfection (c) data collection

Are there names on every resident's personal item?
• Personal hygiene items (Toothbrushes, Combs and etc)
• Nail clippers
• Glucometers and eye drops

Do medications indicate expiry dates? i.e. injections, eyedrops etc..

Screening & Immunization

Is the policy influenza immunization followed?

Is the policy on Pneumonia and Tdap immunization followed?

Is the policy on TB screening followed?

Is the policy on MRSA, VRE & ESBL Screening followed?

Surveillance program

Is there surveillance sheet available in each home area and correctly filled out?

Are the data being monitored and validated daily?

Are the infections tracked monthly?

Are the data analyzed monthly?

Are the infection rates being calculated?

Is the correct data collection sheet in use?

Is the information, that was gathered on every shift about the residents’ infections, analyzed daily to detect the presence of infection and reviewed at least monthly to detect trends for the purpose of reducing the incidence of infections and outbreaks?

Is the surveillance data trended, analyzes and presented at IPAC meeting with action plan created?

Are the number of Residents with ARO in different units is calculated monthly?


Is the process for confirming the outbreak being followed?

Is the investigation checklist being followed?

Are the additional precautions implemented immediately for affected residents?

Is Outbreak Management team activated?

Are the department responsibilities being followed?

Is the Outbreak Management Team Meeting - Record of action being completed?

Is there a folder where all relevant documents related to outbreak filed?

Are there outbreak posters visible at every entrance?

Is high level disinfectant being used?

Hand Hygiene (HH) program

Is there a structured HH program is in place?
• HH Audit
• Team member to assist residents conduct HH before and after meal
• Team members to assist residents conduct HH before and after activity
• Calculating HH rates,data analyzed and action plan developed where appropriate
• Communicating rates with all team members
• Adequate nail and skin care
• Following policies regarding jewelry

Are there Alcohol Based Hand Rub (ABHR) at point of care?

Is the HH compliance before and after using gloves monitored?

Personal protective Equipment (PPE)

Is the algorithm for PPE donning and doffing followed?

Are there PPEs available on entrance to residents's room on additional precaution?

Is there a large enough garbage bin accessible with foot pedal available for residents on additional precaution, within the immediate area?

Fridge Monitoring

Is the medication fridge monitored and temperatures logged twice daily and action taken when out of range?

Is the vaccine fridge monitored and temperatures logged twice daily and action taken when out of range?

Is the specimen fridge monitored and temperatures logged twice daily and action taken when out of range?


Are there annual in-services in addition to relias scheduled? (Flu, outbreak, IPAC gaps and etc.)

Are vendors, Public Health Unit and Public Health Ontario involved in education?

Is there documentation of training kept electronically or paper?

Sharps discarder

Are Safety Engineered needles in use?

Are the sharp discard containers closed before overfilling?

Are team members aware of sharp discard location?

Environmental Hygiene

Is there an environmental audit conducted on a regular basis?
• Audit Tools
• Monitoring system
• Evaluation and validation of data
• Communication to team members

Is the PPE donning and doffing steps properly followed?

Is the proper use of gloves being followed?

Soiled Utility, Clean Utility Rooms, Shower, Tub Room, Linen Room
• PPE availability
• kept locked inaccessible to residents.
• Spray nozzle removed

Are there any issue with pest infestation? (cockroaches, ants, mice and etc.)

Are the rooms visually clean?
• Privacy Curtain
• The Room
• The Bathroom

Disinfection of Non-Critical items

Is the Protocol for disinfection of non-critical items clear?
• Nail Clippers
• Other

Is the responsibility for disinfection of non-critical items clear between departments? (Raised toilet seats, Carbolizing beds, lift equipment and etc)

Is there schedule, protocol or monitoring method/checklist available?


Is the care community aware of using the high level disinfectant during outbreak?

Are there education sessions on the use of disinfectant?
• Cleaning vs. Sanitizing vs. Disinfecting
• Sanitation vs. Low level disinfection vs. high level disinfection
• Dilution/ Titration, Contact time/ dwell time, Mechanical action / Friction
• How to read the label

Is there a sporicidal cleaner available immediately upon request?


Are the clean and soiled areas segregated?

Is there PPE available in laundry?

Is there an ABHR available for team members?

• Briefs separated from dirty cloths
• Bulk feces removed manually before sending to laundry
• Proper wipes are used to clean residents
• Personal belongings removed from clothing before sending to laundry
• Dirty bins disinfected daily?


Are there cleaning protocols in place?

Are all the temperatures (fridge, freezer, hot holding and etc.) checked and logged?

Are team members using proper aprons? (clothes are protected)

Is the previous Public Health visit report reviewed and followed up?

Activity and Programs

Are there plan of care available for pets?

Is there a schedule for cleaning equipment after activity?

Influenza Season

Are there education provided to team members?

Are IPAC Resources being used?

Are there scheduled influenza clinics?


Are PPEs available for residents on additional precaution?

Are there proper signages available for residents on additional precaution?

Are there other areas that require attention?

Add another area


Specify other area

Did it meet the criteria?

Title, Name, and Signature of Inspector
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.