Room number:

Observation of identified precautions :
Type of Isolation Implemented:

Correct Sign/s on the door?

Charting Completed:

If gaps in isolation precautions found, staff contacted:

Additional Comments:

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.