Audit

Utility and Storage Areas

Floors and walls clean?

Corrective Action

Supplies are 18 inches from ceiling?

Corrective Action

Clean Linen Adequately Covered?

Corrective Action

No Supplies on floor?

Corrective Action

Adequate separation of clean and soiled materials?

Corrective Action

Curtains Changed out Quarterly?

Corrective Action

Documentation of Curtain change available?

Corrective Action

Medication prep area is clean and free of clutter?

Area free of Miscellaneous Findings?

Soiled Linen/Dirty/Bio-Hazard Areas

HLD- High Level Disinfectant for Ultrasound Probes properly labeled?

Corrective Action

Documentation of QC and Temperature Log for HDL Complete?

Corrective Action

No clean supplies stored in area?

Corrective Action

Floors/Walls/Cabinets/Ceilings clean?

Corrective Action

Soiled Linen Appropriately bagged?

Corrective Action

Bio-hazard Materials stored off of floor?

Corrective Action

Area free of Miscellaneous Findings?

Pre operative area

Floors and walls clean?

Corrective Action

Furniture Clean and undamaged?

Corrective Action

Alcohol based hand sanitizer available and not expired?

Corrective Action

Soap and paper towels available at hand washing station?

Corrective Action

No supplies under sinks?

Corrective Action

Sharps containers less than 3/4 full?

Corrective Action

Trash cans less than 3/4 full?

Corrective Action

Red bio-hazard bins free from regular trash items?

Corrective Action

Red bio-hazard bins less than 3/4 full?

Corrective Action

No Items on top of linen hampers?

Corrective Action

Area free of Miscellaneous Finding

Post operative area

Floors and walls clean?

Corrective Action

Furniture Clean and undamaged?

Corrective Action

Alcohol based hand sanitizer available and not expired?

Corrective Action

Soap and paper towels available at hand washing station?

Corrective Action

No supplies under sinks?

Corrective Action

Sharps containers less than 3/4 full?

Corrective Action

Trash cans less than 3/4 full?

Corrective Action

Red bio-hazard bins free from regular trash items?

Corrective Action

Red bio-hazard bins less than 3/4 full?

Corrective Action

No excessive Linens stored in the area?

Area free of Miscellaneous Finding?

Hallways, Walkways, Employee changing room, break room and Lobby

Floors and walls clean?

Corrective Action

Hallways and walkways free from obstruction?

Corrective Action

Ceiling tiles clean and in good condition?

Corrective Action

Furniture Clean and undamaged?

Corrective Action

Area free of Miscellaneous Findings?

Nursing, and Physician work stations

Computers, Desks and other furniture Items clean and undamaged?

Corrective Action

No linens in area?

Corrective Action

No food in Area?

Corrective Action

Alcohol based hand sanitizer available and not expired?

Corrective Action

Floors and walls clean?

Corrective Action

Area free of miscellaneous findings?

Dietary/Miscellaneous Items

Ice Machines Clean?

Corrective Action

Patient refrigerator has food properly labeled with expiration date and not expired?

Corrective Action

Corrective Action

Patient food on wire shelving is properly labeled with expiration date and not expired?

Corrective Action

Is area free of shipping boxes on floor?

Corrective Action

Area free of miscellaneous findings?

Operating rooms and Sterile areas

Alcohol base hand sanitizer available and not expired?

Corrective action

Soap and paper towels available?

Corrective action

No supplies under the sink?

Corrective action

Trash cans less than 3/4 full?

Corrective action

Red biohazard bins free from regular trash?

Corrective action

Red biohazard bins less than 3/4 full?

Corrective action

Sharps containers are less than 3/4 full?

Corrective action

No food or drinks in the area?

Corrective action

Floors, ceilings and walls clean?

Corrective action

No exterior shipping containers present in the area?

Corrective action

Air pressure for all rooms are appropriate ( ORs and clean SPD are positive, dirty areas are negative.)

Corrective action

Area free of miscellaneous findings?

Corrective action

Conclusions/Recommendations and Corrective Actions

Confirm Date and Time

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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.