Previous Inspection

Has the last inspection been reviewed?


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
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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.