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.
1.0 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 Injection/Observation 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. Personal protective equipment is 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?

2.11. Drawers well organized and clean?

2.12. Working surfaces are clean?

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

2.14. Plants not present in clinical areas?

2.15. 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 outdates IV solutions, items and medicines?

4.2. Open vials dated and time as per policy?

4.3. Safe injection practices followed as per policy?

4.4. Out of date sterile supplied are not present?

4.5. Double pouch for sharp instruments applied?

5.0. 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?

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.