• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Hand hygiene observation (practices, availability, and proper use of products)

  • Under sink storage contains only cleaning supplies

  • Appropriate separation of clean and dirty (ie no risk for cross contamination between clean and dirty supplies)

  • Environment clean and uncluttered, storage areas are appropriate, and no items stored in corrugated boxes, no outdates noted

  • Areas are free of visible dust (air vents, supply carts, workstations...etc.)

  • Ceiling tiles intact

  • Lights are free of bugs?

  • Sinks are functioning properly and no signs of leaking? Caulk in good condition?

  • Surfaces free of blood, dust, stains and cracks

  • Food and beverages stored in non clinical areas?

Questions for staff

  • What does standard precautions mean to you?<br>(Using appropriate PPE to protect themselves from any potential exposure, based on the situation.)

  • When is it required that you empty linen bags, sharps and trash?<br>(When its 3/4th full or wet)

  • What is the process to return to work after being ill?

  • How would you clean up a blood or body fluid spill?<br>

  • How would you report an exposure to blood, body fluids or a needle stick?<br>(Call the exposure hotline [366-5251] and complete an online injury report [on sanford connect])

  • What is your process for cleaning equipment between patient use? or equipment in the area?<br>

  • How do you know what sani wipe to use when and what is the wet time?<br>(According to manufacturer's instructions)

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.