Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Preparation areas

  • Equipment and supplies stored safely

  • Equipment is stored in a clean environment and easily accessible if required

  • Preparation work surfaces are the correct size, clean and uncluttered

  • Systems for cleaning reusable equipment are quite clear and known

  • Procedure Area

  • Are there appropriate hand cleaning facilities

  • Are there appropriate waste disposal facilities

  • Is the sharps container close to the procedure

  • Have measures been taken to reduce any air movement during the procedure

  • Equipment

  • Is the equipment suitable for the procedure and in good condition

  • Is the equipment clean and intact

  • Aseptic precautions

  • Is correct hand hygiene used as per hand hygiene 5 moments

  • Is PPE used appropriate

  • Are sharps and equipment disposed of safely after procedure

  • Is hand hygiene applied on removal of gloves at end of procedure

  • Aseptic technique

  • Correct application of Standard or Surgical ANTT

  • Key parts/key sites identified and protected

  • Key parts/key sites are cleaned effectively prior to use

  • Key parts/key sites are allowed to dry before use

  • Non touch technique is evident and effective

  • General aseptic fields are managed correctly

  • Critical aseptic fields are managed correctly

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.