Sample - COVID-19 Healthcare Providers Preparedness Checklist (CDC)

• Conducted on

  Date

• Prepared by

• Location
  Address

• This checklist is derived from the Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19 by the Centers for Disease Control and Prevention (CDC).
  https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp-preparedness-checklist.pdf

Review

• Review your infection prevention and control policies and CDC infection control recommendations for COVID-19 for:

• Assessment and triage of patients with acute respiratory symptoms

  Done

  To Do

• Patient placement

  Done

  To Do

• Implementation of Standard, Contact, and Airborne Precautions, including the use of eye protection

  Done

  To Do

• Visitor management and exclusion

  Done

  To Do

• Source control measures for patients (e.g., put facemask on suspect patients)

  Done

  To Do

• Requirements for performing aerosol generating procedures

  Done

  To Do

• Be alert for patients who meet the persons under investigation (PUI) definition

  Done

  To Do

• Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.

  Done

  To Do

• Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed coronavirus disease 2019 patient.

  Done

  To Do

• Remain at home, and notify occupational health services, if you are ill.

  Done

  To Do

• Know how to contact and receive information from your state or local public health agency.

  Done

  To Do

Sign-off

• Comments/Recommendations

• Name & Signature

  Sign