Patient Room

Enter room number in field below

Is the room occupied?

Ceiling tiles free from staining

ABHR available/working

Soap, water and paper towels available

Sharps container is less than 3/4 full

No supplies stored under sink

Soiled linen in bag; not overfilled,mhamper covered

Medication storage area clean

Refrigerator labeled to identify the approved use

Items within refrigerator according to label

Isolation Room

Standard precautions
clean Utility
Soiled Utility
EVS Closet/Cart

Clean in appearance

Free from safety concerns

Container labeled

Appropriate PPE available

Cart organized

Public Use Restroom

All surfaces appear clean

Add media

Hand-washing supplies available

Add media

Free from trash/debris

Add media


ICRA posted

Add media

ICRA within date range

Add media

ICRA being followed

Add media

Waiting Area/Entry

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

Add media

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.