Infection Control Monitoring

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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, visitors and health care personnel?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 1.3. Free from bar soaps?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 1.5. Food handlers able to demonstrate good handwashing techniques?

  Yes

  No

  N/A

2.0. Waste Management

• 2.1. Waste containers clean?

  Yes

  No

  N/A

• 2.2. Waste containers covered and with labels?

  Yes

  No

  N/A

• 2.3. Waste containers foot pedal operational and in good condition for kitchen waste?

  Yes

  No

  N/A

3.0 Refrigerators/Freezers

• 3.1. Daily checklist completed for temperatures?

  Yes

  No

  N/A

• 3.2. Fridge temperature is maintained?

  Yes

  No

  N/A

• 3.3. Designated food fridge is clean?

  Yes

  No

  N/A

4.0. Storage Area

• 4.1. Floors and walls clean?

  Yes

  No

  N/A

• 4.2. Horizontal and vertical surfaces are clean?

  Yes

  No

  N/A

• 4.3. Bottom shelf is solid?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

5.0. Kitchen Area

• 5.1. Floor around preparation area is clean?

  Yes

  No

  N/A

• 5.2. Sink unit is clean?

  Yes

  No

  N/A

• 5.3. Liquid soap available?

  Yes

  No

  N/A

• 5.4. Flat surfaces clean and free from stains?

  Yes

  No

  N/A

• 5.5. Ceiling are not discolored/wet/missing or damaged?

  Yes

  No

  N/A

• Two-sink dishwashing method is observed?

  Yes

  No

  N/A

6.0. Corridors/Environment

• 6.1. Furniture is clean and in a good state?

  Yes

  No

  N/A

• 6.2. The wall is clean and dust free?

  Yes

  No

  N/A

• 6.3. Free of obstruction and equipment?

  Yes

  No

  N/A

7.0. Food Handlers

• 7.1. Awareness about the importance of hand hygiene?

  Yes

  No

  N/A

• 7.2. Wearing appropriate PPE during food handling and transport such as gloves and hairnets?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 7.4. Wear clean clothes daily?

  Yes

  No

  N/A

• 7.5. Clean shaven and shower daily?

  Yes

  No

  N/A

• 7.6. Food handlers wearing jewelry, rings, fingernail polish, bandages?

  Yes

  No

  N/A

• 7.7. Do food handlers have illnesses, infections or injury (boils and cuts) that can contaminate food in the production area?

  Yes

  No

  N/A

• 7.6. Periodic examination (stool analysis) done for all food handlers?

  Yes

  No

  N/A

Additional Comments

• Additional Comments

Recommendations

• Investigator's Signature

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• Received by:

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