Title Page

  • Conducted on

  • Prepared by

  • Location
  • 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

  • Patient placement

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

  • Visitor management and exclusion

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

  • Requirements for performing aerosol generating procedures

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

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

  • 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.

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

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

Sign-off

  • Comments/Recommendations

  • Name & Signature

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.