Public Health Apps

Infection Prevention & Life Safety Checklist

While the primary role of hospital maintenance and engineering staff is to service the building and equipment, it plays a crucial role in infection prevention and other safety concerns along with the healthcare professionals they work with. This infection prevention and life safety checklist can be used to evaluate a hospital’s environment and staff protocols for preventing the spread of COVID-19 and other pathogens.

Source: https://www.ashe.org/infection-prevention-life-safety-checklist

Infection Prevention & Life Safety Checklist iPhone, iPad Infection Prevention & Life Safety Checklist Android Infection Prevention & Life Safety Checklist Web, Desktop
Infection Prevention & Life Safety Checklist

Date of Inspection

Facility Name

Facility Address

Unit

Infection Prevention

Can staff demonstrate proper hand hygiene

Notes

Can staff articulate how patient care equipment is cleaned

Notes

Does staff understand their responsibilities of isolation precautions and signage ppe

Notes

Can staff describe how to identify a C-diff precautions room

Notes

Can staff describe how medical waste should be disposed of

Notes

Are refrigerator logs complete - temps within range

Notes

Are medication refrigerators free of food

Notes

Is clean linen covered and stored properly

Notes

Are ceiling tiles clean, free of stains, and intact

Notes

Are corridors clear of unused or soiled equipment

Notes

Are areas under sinks clear of storage

Notes

Is PPE attire properly worn

Notes

Are supplies stored appropriately (ie. Not on hand rails, tops of glove boxes, window sills, Workstation on Wheels, tables, floors)

Notes

Are patient care areas free of food/drinks

Notes

Is dirty linen appropriately removed (in proper bags and soiled utility rooms)

Notes

Are walls and casework free of damage providing a smooth cleanable surface

Notes

Is upholstered furniture and casework free of damage providing a smooth cleanable surface

Notes

Are floors clean

Notes

Infection Prevention Score

Life Safety

Can staff describe their role in a fire - RACE/PASS, how to alert, nearest fire extinguisher/pull station

Notes

Are egress hallways clear of all equipment (except in-use isolation carts/cleaning carts)

Notes

Are electrical items in good repair - no daisy-chained surge protectors

Notes

Are doors to hazardous areas kept closed and latched (unless on magnetic hold open devices)

Notes

Are fire extinguishes inspected monthly

Notes

Do all fire doors close and positively latch (absent wedges and/or tape)

Notes

Soiled linen or trash containers do not exceed 32 gal in total capacity

Notes

Proper placement of alcohol based hand rubs (clear of electrical outlets and light switches)

Notes

Are patient care departments free of space heaters

Notes

Do Trash chute doors self close and latch

Notes

Is storage at least 18 inches from sprinkler heads

Notes

Are compressed medical gas cylinders secured properly and stored correctly

Notes

Do staff know location and proper use of med gas shut-offs

Notes

Is there 36'' clearance around electrical panels, med gas shut-offs, fire extinguishers, pull stations

Notes

Are exit signs visible and properly illuminated

Notes

Is flooring in good repair - free of slipping/tripping hazards

Notes

Where eye wash stations are present, are test logs current

Notes

Life Safety Score