MRO audit tool

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Add media

  Media

AREA 1

Transmission based precautions required

• Transmission based precautions required

  Select Contact - no gloves required Contact - gloves required Contact-long sleeve gown & gloves Droplet Airborne Airborne and contact

  • Contact - no gloves required
  • Contact - gloves required
  • Contact-long sleeve gown & gloves
  • Droplet
  • Airborne
  • Airborne and contact

Room type

• Room type

  Select One bed - ensuite One bed - no ensuite One bed - shared ensuite 2 bed bay 3 bed bay 4 bed bay Negative pressure room - ante room Negative pressure room - no ante room Positive pressure room Other

  • One bed - ensuite
  • One bed - no ensuite
  • One bed - shared ensuite
  • 2 bed bay
  • 3 bed bay
  • 4 bed bay
  • Negative pressure room - ante room
  • Negative pressure room - no ante room
  • Positive pressure room
  • Other

• Room number / Bay number

Signage

• The Infection Control signage is correctly displayed.

  Yes

  No

  N/A

Outside bay/room setup

• Isolation trolley present

  Yes

  No

  N/A

• Appropriate apron/gown present

  Yes

  No

  N/A

• Disinfectant wipes present

  Yes

  No

  N/A

• ABHR present

  Yes

  No

  N/A

• Gloves present

  Yes

  No

  N/A

• Appropriate masks present

  Yes

  No

  N/A

• Patient chart outside room

  Yes

  No

  N/A

• Negative pressure log sheet completed correctly

  Yes

  No

  N/A

Inside bay/room setup

• ABHR is on end of bed

  Yes

  No

  Not viewed

• Waste bag in room

  Yes

  No

  Not viewed

• Color of waste bag in room

  Yellow

  Black

  Purple

  Not viewed

• Gloves present

  Yes

  No

  N/A

Action required

• Action required:

Audit completed by:

• Add signature

  Sign