Audit

Patient Room

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Is the room occupied?

Ceiling tiles free from staining

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ABHR available/working

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Soap, water and paper towels available

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Sharps container is less than 3/4 full

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No supplies stored under sink

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Soiled linen in bag; not overfilled,mhamper covered

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Refrigerator labeled to identify the approved use

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Items within refrigerator according to label

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Isolation Room

Correct sign in place (right sign, right reason)
Enter the room number and isolation type in the field below.

Supplies and PPE available

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Staff compliant with policy

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Airborne precaution: Patient placed in negative airflow room according to policy

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Airborne precautions: Door closed and negative airflow functioning properly

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Airborne Precautions: Inquire with Charge Nurse re:RNs on unit who are fit tested. List names of employees below.

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Airborne Precaution: trash can located outside door

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Unit

Non offensive odor

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General appearance of cleanliness

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Ceiling tiles free from staining

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Flooring free from dust and dirt

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Vents free from dust

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Sprinkler heads free from dust

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Firelight alarm free from dust

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Linen carts covered

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Soiled linen bag not overfilled

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Mediagenic keyboards cleaned

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Refrigerator labeled to identify the approved use

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Items within according to label

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Ice machine visibly clean

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Unit furniture and textiles intact and able to be effectively cleaned and/or disinfected

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Medication storage area clean

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Standard Precautions

HCWs food/beverages permitted in designated areas per policy
(excluding areas where specimens may be present)

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PPE per policy

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Clean Utility

Designed to meet basic IC compliance

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Clean items stored appropriately

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Review for outdated items

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Soiled Utility

Room appropriately labeled with name and biohazard symbol

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Appears clean and disinfected on a regular basis (including floors)

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Mounted sharps container less than 3/4 full

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Gloves available

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Splash PPE by hopper

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Area for hand cleansing

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Negative airflow functioning properly

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EVS Closet/Cart

Clean in appearance

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Free from safety concerns

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Cleaning supplies appropriately labeled

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Appropriate PPE available

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Cart organized

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Public Use Restroom

All surfaces appear clean

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Hand-washing supplies available

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Free from trash/debris

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ICRA

ICRA permit posted

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ICRA within date range

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ICRA being followed

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Waiting Area/Entry

If appropriate, supplies for respiratory hygiene available and posted instructions in place

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Additional Comments and Photos

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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.