Date and time of audit:


Room Number:

High Touch Room Surfaces

Bed Rails/ controls

Tray Table

IV pole (grab area)

Call box/button


Bedside Table Handle


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?


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.