Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Did the representative ask about travel upon hearing the symptoms?
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Was the patient instructed to put a mask on.
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Did staff touch the patient?
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Did triage nurse dress in basic PPE?
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Was physician notified immediately?
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Was the call made to the infection Preventionist?
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Did IP call the ID Doc?
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Did IP call the state department of health?
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Did IP call the cdc?
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Did IP call the supervisor?
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Did the supervisor call maintenance?
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Did the supervisor call SMT on call?
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Did they wipe down the counter or call housekeeping to clean area of travel?
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Did triage nurse dress in basic PPE?
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Did the staff follow the pre-designated route for ebola patient (ESD bed 5)?
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Did the staff talk of room setup?
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Did the staff retrieve the Ebola cart?
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Did the staff operate room controls appropriately?
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Did the staff identify the use of the buddy system?
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Did the nurse donn ebola PPE to enter the patient room?
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Did the MD donn Ebola PPE to enter the patient room?
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Notes:
