Department: (i.e. Transport and Lift Team; Chaplain; Volunteers)


1. Staff able to find or state the location of the hospital's Infection Control Policies & Procedures

2. Able to name three types of isolation / precautions and their indications.

3. Able to state the CDC recommended personal protective equipment (PPE) for a specific type of isolation / precaution: (name one of the isolation precautions)

4. TRANSPORT TEAM: Able to verbalize / demonstrate cleaning/disinfection of side rails and removal of gloves prior to transporting an isolation patient to another part of the hospital.

5. Able to describe which way the air flows in a negative airflow room and anteroom.

6. State who checks negative pressure rooms? How often? Where is this recorded?

7. Staff able to articulate steps to check a negative airflow room for correct operation. What is the correct procedure if the room doesn't check out?

8. Able to state the Hand Hygiene policy including the fingernail standards for healthcare workers.

9. Able to name steps to cleanup a biohazard spill of blood or body fluids.

10. Able to identify biohazardous waste containers; list three examples of biohazard waste.

11. Able to articulate the department's performance improvement activities to reduce hospital onset infections happening in the unit? In the hospital?

12. Able to describe three actions to take if exposed to blood or body fluids.

13. Able to state three steps to take if a patient or visitor in a waiting area is suspected of having a contagious respiratory disease.

14. Able to state the the contact/dwell time or both hydrogen peroxide and bleach wipes.

15. Staff able to articulate contact/dwell times for hospital approved disinfectants. (Bleach and Hydrogen peroxide)


16. Staff is observed performing correct hand hygiene: a) washing hands for at least 15 seconds with alcohol foam or soap and water, b) using towel to turn off faucets and touch door handles, and c) between patient contacts.

17. Direct patient care staff have no artificial fingernails; nails extend < 1/4" from fingertip.

18. Staff correctly observed isolation precautions posted for patients.

19. Correct contact/dwell times observed for hospital approved disinfectants. (Bleach and Hydrogen peroxide)


20. Storage area is clean and organized with no outside shipping containers

21. Sterile items are stored in a manner that will not compromise sterility

22. Storage shelving/carts are: 18" from the ceiling, 8-10" above the floor, and at least 2 " from the outside walls

23. Sterile supplies are rotated on the "first in, first out" concept.

24. No outdated supplies found.

25. Staff is able to articulate decontamination process of dirty equipment.

26. Clean Equipment Storage Room only contains clean equipment.

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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.