Information

  • 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 Patient Exam Rooms

  • 2.1. Floor and walls clean?

  • 2.2. Cubicle curtains unsoiled and free of tears?

  • 2.3. Furniture is clean and in good condition?

  • 2.4. Sink is clean and storage area empty and clean?

  • 2.5. Liquid soap and paper towel dispenser are stocked and working?

  • 2.6. Alcohol hand sanitizers are available?

  • 2.7. Gloves, PPE available?

  • 2.8. No food or drink in patient care areas?

  • 2.9. Vent grill is dirt free?

  • 2.10. Couch covers or couch rolls changed after every patient used?<br>

  • 2.11. Drawers well organized and clean?

  • 2.12. Working surfaces are clean?

  • 2.13. Equipment decontamination done?

  • 2.14. Mattress pad and couch is without tears or puncture holes?

  • 2.15. Plants not present in clinical areas?

  • 2.16. Cleaning equipment not containing any ferrous or ferromagnetic material?

  • 2.17. All surfaces on the MRI table (inside the magnet bore, magnet gantry and MRI coils is clean?

  • 2.18. The pad is inspected using a magnifying glas, particularly at the seams and sponge if free of fraying or tears?

  • 2.19. Cleaning schedule is followed and updated?

  • 2.20. Is equipment properly cleaned and stored?

3.0 Waste Management

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

  • 3.2 Waste containers covered and with labels?

  • 3.3. Contaminated instruments or disposables placed on designated area not mixed with clean items?

  • 3.4. Regulated medical waste discarded appropriately?

  • 3.5. Waste clearly segregated?

  • 3.6. Sharp containers secured and labeled appropriately?

  • 3.7. Sharp bins not mixed with any general/biomedical waste?

  • 3.8. Sharp containers are no more than 3/4 full?

  • 3.9. Staffs are aware not to bend, recap ore remove contaminated needle or sharps unless it is absolutely necessary?

4.0 Medications/ Items

  • 4.1. No outdated IV solutions, items and medicines?

  • 4.2. Open vials dated and times as per policy?

  • 4.3. Safe injection practices followed as per policy?

  • 4.4. Out of date sterile supplies are not present?

5.0. Utility and Storage Room

  • 5.1. Floors and walls clean?

  • 5.2. Horizontal and vertical surfaces are clean?

  • 5.3. Adequate separation of clean and soiled?

  • 5.4. Bottom shelf is solid?

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

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

  • 5.7. No supplies stored in the dirty utility room?

  • 5.8 Soiled linen is bagged accordingly?

6.0. Chemical Safety

  • 6.1. Material Safety Data Sheets available for all chemicals?

  • 6.2. Risk assessments completed for hazardous substance?

  • 6.3. All containers labelled correctly?

  • 6.4. Unused substances disposed of?

  • 6.5. Do special storage conditions apply?

  • 6.6. Workers trained in the use of hazardous substance?

  • 6.7. If required is PPE available?

  • 6.8. Are eye washes and showers easily accessed?

7.0. Corridors/ Hallways/ Environment

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

  • 7.2. The wall is clean and dust free?

  • 7.3. Free of obstruction and equipment?

  • 7.4. Reception area is clean and work surface clean and free from clutter?

  • 7.5. OTC and compressor room is clean and maintained and dust free?

Additional Comments

Recommendations:

  • Inspector's signature

  • Received by:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.