Staff interview/ record review

Water cultures obtained as schedule.

Water testing done per policy.

Evidence of actions taken appropriately related to cultures results per decision tree and documented

MRSA screening completed as appropriate.

Hand Hygiene

Hand hygiene: staff perform appropriately

Hand hygiene: sinks & appropriate hand hygiene products are available.

Personal protective equipment

Personal protective equipment used appropriate.

Personal protective equipment readily available

Sharps containers

Sharps containers: puncture-resistant, leakproof, labeled (red).


Medications: labeled appropriately with expiration dates.

Medications: secured

Clean supply storage

Designate clean storage from dirty.

Supplies stored off floors and supply area free of dust, dirt, etc. No cardboard boxes.

No expired supplies noted.

Cleaning of patient care equipment

Reusable patient care items and equipment are cleaned/ reprocessed and stored appropriately.

Line care

Dressing in good condition and

Use of Curos on Tego connectors.

Rounds completed by:

Signature of person making rounds
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.