• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Date and time of audit:

  • Unit:

  • Room Number:

High Touch Room Surfaces

  • Bed Rails/ controls

  • Tray Table

  • IV pole (grab area)

  • Call box/button

  • Telephone

  • Bedside Table Handle

  • Chair

  • Room sink

  • Room light switch

  • Room inner door knob

  • Bathroom inner door knob/plate

  • Bathroom light switch

  • Bathroom handrails by toilet

  • Bathroom Sink

  • Toilet seat

  • Toilet flush handle

  • Toilet bedpan cleaner

Evaluate the following if present:

  • IV pump control

  • Multi-module monitor controls

  • Multi-module monitor touch screen

  • Multi-module monitor cables

  • Ventilator control panel

  • Which method was used for monitoring?

  • Notes:

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.