• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Add media


Transmission based precautions required

  • Transmission based precautions required

Room type

  • Room type

  • Room number / Bay number


  • The Infection Control signage is correctly displayed.

Outside bay/room setup

  • Isolation trolley present

  • Appropriate apron/gown present

  • Disinfectant wipes present

  • ABHR present

  • Gloves present

  • Appropriate masks present

  • Patient chart outside room

  • Negative pressure log sheet completed correctly

Inside bay/room setup

  • ABHR is on end of bed

  • Waste bag in room

  • Color of waste bag in room

  • Gloves present

Action required

  • Action required:

Audit completed by:

  • Add signature

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.