• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Previous Inspection

  • Has the last inspection been reviewed?

  • Details

Managers - Infection Control performed an inspection of your unit. Please review your survey and document your Plan of Correction next to each deficiency.

1.0 Hand Hygiene

  • 1.1. Hand sanitizer is available and accessible for the patients and visitors in all waiting areas?

  • 1.2. Available liquid soap within all treatment rooms?

  • 1.3. Wall mounted paper towels available near each sink?

  • 1.4. Free from bar soaps?

  • 1.5. Posters in appropriate locations demonstrating good handwashing techniques?

  • 1.6. Clinical staff able to demonstrate good handwashing techniques?

  • 1.7. Staff able to apply 5 moments of hand hygiene?

2.0. Environment

  • 2.1. Overall appearance of the environment is tidy and uncluttered with only appropriate, clean and well maintained furniture used?

  • 2.2. Tables are tidy and uncluttered to enable effective cleaning?

  • 2.3. Chairs are free from rips and tears?

  • 2.4. All dispensers, holders and all parts of the surfaces of dispensers of soap and alcohol gels, paper towel are visibly clean with no body substances, dust, dirt or debris or adhesive tape?

  • 2.5. The complete floor, including edges and corners are visibly clean with no visible body substances, dirt, dust or debris?

3.0. Waste management

  • 3.1. Waste containers, clean, operational and in good condition?

  • 3.2. Waste containers covered with labels?

  • 3.3. There is evidence that staff are segregating waste correctly?

  • 3.4. Staff are aware of the waste segregation procedures?

  • 3.5. There is evidence that the waste contractor is registered with a valid license (check records).

4.0. Storage Room

  • 4.1. Floor and walls clean?

  • 4.2. Horizontal and vertical surfaces are clean?

  • 4.3. Bottom shelf is solid?

  • 4.4. No supplies stored 6" from the floor?

  • 4.5. No supplies stored touching 18" from the ceiling

5.0. Spillage and/or Contamination with Blood and Body Fluids

  • 5.1. Staff are aware of procedures for dealing with body fluid spillages?

  • 5.2. Staff have been checked for hepatitis titer?

  • 5.3. Dedicated blood and body fluid spillage kits are available for decontaminating and cleaning body fluids and are in date?

6.0. Medications/Vaccines

  • 6.1. No outdated items and medicines?

  • 6.2. Regulated drugs/medicines are monitored and updated?

  • 6.3. The vaccine refrigerator is fit for purpose and is not a domestic refrigerator?

  • 6.4. The refrigerator vaccine shows maximum and minimum temperatures?

  • 6.5. Temperature checks are performed and recorded daily?

  • 6.6. All vaccines are in date?

Additional Comments

  • Additional Comments


  • Inspector's signature

  • Received by:

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