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/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?

Exam Rooms: ER

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

Check manometer on isolation room, Is it operating correctly? (Does the red light come on when the door is held open for an extended amount of time?)

Corrective Action

Area free of Miscellaneous Finding

Hospital Beds: IP Rooms

No Items on top of linen hampers?

Corrective Action

Check manometer on isolation room, Is it operating correctly? (Does the red light come on when the door is held open for an extended amount of time?)

Corrective Action

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 Inpatient Rooms?

Area free of Miscellaneous Finding?

Hallways, Walkways, Employee 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?

ER/ IP 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?

Area free of miscellaneous findings?

Corrective Action

Dietary/Miscellaneous Items

Ice Machines Clean?

Corrective Action

Patient refrigerator has food properly labeled with expiration date?

Corrective Action

Patient food on wire shelving is properly labeled with expiration date?

Corrective Action

Is facility free of shipping boxes on floor?

Corrective Action

Area free of miscellaneous findings?

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.