Information
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Client / Site
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Conducted on
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Prepared by
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Personnel
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Unit Observed
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Hand washing observed and soap available
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Paper towels available
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Employee verbalized location of eye wash station
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Area Clean
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PPE available
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Medication room clean
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Equipment Clean
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Soiled Linen handled with gloves
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Infectious waste disposed of in biohazard container
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Sharps containers secured
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Sharps container replaced when 3/4 full
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Clean linen supply covered and stored to avoid contamination (ie. solid bottom and curtain covered)
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Crash cart clean and free of dust
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Proper attire worn
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Ceiling vents clean
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Correct isolation signs on doors if appropriate
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Infectious waste covered
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Biohazard labels in appropriate areas
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Refrigerator temp logged daily or auto temp monitor<br><br>36-45 degrees F for meds<br>32-41 degrees F for food<br>0-20 degrees F for freezer
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Clean and dirty supplies seperated
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Universal Precautions observed
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Hand washing
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PPE worn if indicated
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Soiled linen if indicated
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Infectious waste disposed of in biohazard container
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High level dusting appropriate
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Oxygen tanks stored properly
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Storage room cleanliness and baby isolet clean and covered
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Comments
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Return to me on the date below with resolutions please
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Completed by
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handoff given to
