Information

  • 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)

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