• 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.

1.1. Housekeeping

Hand Hygiene

  • 1.1. Awareness about the importance of hand hygiene?

  • 1.2. Houskeeping staff perfrom hand washing before and after the procedure?

  • 1.3. Availability of liquid soap dispenser with approved soap only?

Personal Protective Equipment

  • 1.4. Awareness about the importance of PPE?

  • 1.5. Wearing appropriate PPE during cleaning procedure?

Cleaning and Disinfecting Procedure

  • 1.6. Educated and well oriented about the proper flow of cleaning (cleanest to dirtiest)?

  • 1.7. Takin into consideration the type of housekeeping surface when cleaning (high-touch and low-touch surface)?

  • 1.8. Consider the nature of the item/space to be disinfected/cleaned?

  • 1.9. Thorough cleaning before disinfecting of surface observed?

  • 2.0. Observe duration and temperature of germicide contract?

Chemical Used

  • 2.1. Accessibility of MSDS "Material Safety Data Sheet"?

  • 2.2. Correct and updated labels of chemicals used?

  • 2.3. Exact dilution of chemicals for cleaning and disinfecting in practice?

  • 2.4. Proper placement of chemical solution is evident?

Spill Kit

  • 2.5. Orientation and training about CODE BROWN (type of spill and kit)?

  • 2.6. Availability of spill kits on respective area?

  • 2.7. Up to date chemicals and single used PPE inside the kit were checked at least once a week?

Cleaning Equipment

  • 2.8. Mops with detachable head and sent for laundry daily or if contaminated?

  • 2.9. Buckets were cleaned dried after use?

  • 2.10. Daily washing and drying of reusable gloves?

Linen Management

  • 2.11. Linens placed in an impermeable designated and closed bag?

  • 2.12. Proper segregation on different hampers?

  • 2.13. Observed close doors at housekeeping dirty stock room?

  • 2.14. Arranged/organized clean linens at clean linen stock room?

  • 2.15. Inventory recording for laundry in practice?

Waste Management

  • 2.16. Collection of waste according yo quality?

  • 2.17. Collection of waste at 3/4 full?

  • 2.18. Changing of new waste bin bag after waste collection?

Personnel Hygiene

  • 2.19. Wear clean clothes daily?

  • 2.20. Clean shaven shower daily?

  • 2.21. No spitting anywhere and inside facility?

  • 2.22. Food and drinks should be taken in the designated room?

Additional Comments

  • Additional Comments


  • Inspector's Signature

  • Received by:

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