Public Health Inspection Checklist for Healthcare Institutions/ Nursing Homes/Infirmaries in light of COVID-19

• Conducted on

  Date

• Prepared by

• Location
  Address

• Person(s) conducting inspection

• Status of Institution

  Satisfactory

  Unsatisfactory

• Action Taken

  Select Recommend Closure Additional Time Given To Correct Breech N/A

  • Recommend Closure
  • Additional Time Given To Correct Breech
  • N/A

Contacts and Records

• Name of Institution

• Parent Company (if Applicable)

• Address
  Address

• Email Address

• Contact Numbers

• Name of Manager/CEO

• Number of Shifts Operated

• Number of Staff /Shift

• Number of Staff reported absent

• Number absent due to illness

• Number of Residents/Clients/Patients

• Average number of clients/patients seen Daily

• Residents/Clients/Patients Record Seen:

  Yes

  No

  N/A

I. Sanitary and Hygiene Practices

• A. Sanitary Conveniences

  Yes

  No

  N/A

• Adequate

  Yes

  No

  N/A

• Clean Condition

  Yes

  No

  N/A

• B. Handwashing Facility

  Present

  Not present

  N/A

• Adequate (at minimum - entrance to the <br>building; nurse’s station(s); toilet facilities; <br>kitchen; recreational and dining area)

  Yes

  No

  N/A

• Equipped

  Yes

  No

  N/A

• Strategically placed

  Yes

  No

  N/A

• C. Hand Sanitizers strategically placed (equipped with <br>sanitizer having at least 62% alcohol base, and <br>adequate)

  Present

  Not present

  N/A

• D. Water safe and adequate quantity available

  Present

  Not present

  N/A

• E. Water Quality records (if trucked) and trucking <br>information in place

  Present

  Not present

  N/A

II. Social Distancing and COVID-19 Risk Reduction Measures

• A. Temperature checks on entering the building (related <br>records updated)

  Yes

  No

  N/A

• B. Implementation (and documentation) of Stay at Home if sick Policy for staff (they should remain at home and call to notify the HR department and the MOHW)

  Yes

  No

  N/A

• C. Residents/clients/patients subjected to daily <br>temperature checks and same recorded

  Yes

  No

  N/A

• D. Multi-use devices properly cleaned and disinfected <br>after use on each patient/client/resident and prior to use by staff. (example manual sphygmomanometer (blood pressure monitors), stethoscope, thermometers)

  Yes

  No

  N/A

• E. Established regulatory provision in place (6 feet <br>distance between beds observed)

  Yes

  No

  N/A

• F. Social distancing provisions observed in recreational, common and dining areas.

  Yes

  No

  N/A

• G. Absence of congregating of staff and <br>residents/clients/patients throughout the facility or on the compound (evidence of such systems in place to include scheduled dining and recreation)

  Yes

  No

  N/A

• H. The requisite signs for stair use or two persons per <br>elevator erected (where applicable)

  Yes

  No

  N/A

• I. Separate entrance and exits in place or evidence of <br>controlled entry and assigned routes observed

  Yes

  No

  N/A

• J. Evidence of staggered dining and recreational <br>assignment per group

  Yes

  No

  N/A

III. General Cleaning and Sanitation

• A. Waste Storage and Disposal (Medical and General)

  Yes

  No

  N/A

• Waste separation using established MOHW coding system in place

  Yes

  No

  N/A

• Proper waste storage facilities

  Yes

  No

  N/A

• Document in place regarding disposal of waste

• B. Garbage Bins

  Yes

  No

  N/A

• Frequently Emptied (no more than ¾ full)

  Yes

  No

  N/A

• Hands Free or foot operated receptacle

  Yes

  No

  N/A

• Lined

  Yes

  No

  N/A

• Sufficient and strategically placed throughout the health care facility

  Yes

  No

  N/A

• C. Furnishing, fixture and equipment designed to allow for easy cleaning

  Yes

  No

  N/A

• D. Cleaning and disinfection guidelines in place for the <br>facility, appropriate and accessible<br>

  Yes

  No

  N/A

• Guidelines posted at appropriate locations

  Yes

  No

  N/A

• E. Cleaning and Disinfection schedule (posted and updated)

  Yes

  No

  N/A

• F. Recommended cleaning and disinfection agents <br>observed and properly stored (MSDS present for <br>chemicals used)

  Yes

  No

  N/A

• G. Linen properly cleaned, stored and handled

  Yes

  No

  N/A

• H. Dirty linen properly handled (segregated and transported)

  Yes

  No

  N/A

• <br>I. No carpeted floor in building

  Yes

  No

  N/A

• J. All designated support staff provided with appropriate PPE for cleaning and disinfection (gloves, masks, face shields, water-proof coverall)

  Yes

  No

  N/A

• K. Compound and facility maintained in a clean and sanitary manner

  Yes

  No

  N/A

IV. Handling of Sick Persons

• A. Suitable isolation area designated

  Yes

  No

  N/A

•  Proper handwashing station

  Yes

  No

  N/A

•  Bed(s) has/have impervious and cleanable covering

  Yes

  No

  N/A

• B. All applicable MOHW Infection Prevention Control (IPC) measures observed

  Yes

  No

  N/A

• C. Up-to-date and well-maintained records of all workers <br>who present with or complain of symptoms<br>

  Yes

  No

  N/A

• D. Ministry of Health and Wellness contact information on record and posted

  Yes

  No

  N/A

• E. Personal protective equipment available for use by healthcare personnel, other staff members, residents/clients/patients at the facility

  Yes

  No

  N/A

V. Transportation

• A. Register of all contracted drivers and their vehicles well maintained and available (to include ambulance service)

  Yes

  No

  N/A

• B. Log of all staff members transported on staff bus for each trip

  Yes

  No

  N/A

• C. Log of all residents/clients/patients or staff transported or transferred to a healthcare facility or another healthcare facility (as the case may be)

  Yes

  No

  N/A

• D. Procedures and guidelines for cleaning and <br>sanitization of vehicles observed (or described)

  Yes

  No

  N/A

VI. Personal Protective Equipment (PPE) Use and Disposal

• A.Types of PPE observed in use (list)

  Yes

  No

  N/A

• B. Appropriateness of the PPE used

  Yes

  No

  N/A

• C. Guidelines for PPE use and disposal in place and <br>practiced (appropriate notice/ signs posted, proper use and disposal signs noted)

  Yes

  No

  N/A

VII. Communication

• A. Evidence of training for staff in place as it relates to COVID-19 based on MOHW guidelines (staff meeting register or training schedule, meeting agenda and attendance register seen)

  Yes

  No

  N/A

• B. Relevant health education pamphlets/ posters <br>strategically placed throughout the center

  Yes

  No

  N/A

Ventilation

• A. Use of natural ventilation observed

  Yes

  No

  N/A

• B. Preventative maintenance programme in place observed

  Yes

  No

  N/A

• C. Where applicable, the cleaning and maintenance <br>schedule for all air handling units available, up-to-date

  Yes

  No

  N/A

• Comments