Enviromental Audit Report
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Medication fridge is clean and only used for medications | ||||
| Sterile solutions are dated when opened and dispose within 24 hours | ||||
| Temperature of the fridge must be checked daily and recorded (2 - 8 degree Celsius). Actions taken if fridge temperature is out of range | ||||
| Medication is labeled with date and time of opening |
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Correct isolat ion signage is used to indic ate the isolat ion room | ||||
YES | NO | NA | REMARKS | |
Isolation trol ley must be eq uipped with PP E and must be kept clean and tody | ||||
Door is kept c losed at all t imes | ||||
Negative press ure room shoul d be check for its function daily and reco rded |
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Clean linen di stributed to d epartment unit s on clean, co vered carts | ||||
Clean linen is stored in cle an utility roo m or clean cab inet, cabinet doors must be kept closed at all times and only accessib le to staff. | ||||
Linen room are for the stora ge of clean li nen items only and not used for storage of any other equ ipment. | ||||
Soiled linen i s segregated i n appropriate color coded ba g and kept in sluice / dirty room | ||||
Linen bags not overfilled & easy to ensure | ||||
Linin skip is clean and cove red | ||||
Genera; waste and clinical w aste are segre gated | ||||
Sharp bin are assembled corr ectly, and are closed after it is 3/4 full | ||||
YES | NO | NA | REMARKS | |
Clinical waste bins are not over filled | ||||
Sharp containe rs are safely stored in a de signated area and do no pres ent a risk to patients/ visi tors. |
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| General waste and clinical waste are segregated | ||||
| Sharp bin are assembled correctly, and are closed after it is 3/4 full | ||||
| Clinical waste bins are not over filled | ||||
| Sharp containers are safely stored in a designated area and do no present a risk to patients/ visitors. |
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Counter clean, neat & tidy, free from flui d & blood stai n | ||||
Staff Room / p antry area are clean & tidy | ||||
All sterile in struments / it ems must be st ored in clean containers, de dicated area, and must be wr apped free fro m stain & cob webs. | ||||
Waiting area ( OPD 5, OPD 8) clean & tidy. | O | |||
YES | NO | NA | REMARKS | |
All equipment are clean and free of stains (e.g: GA mach ine, infusion pumps and syri nge pumps, cra sh cart, troll ey) and proper ly stored. | ||||
Floors, wall c lean and free from visible d irt & stains. | ||||
Ceilings free from stains, h oles and penet rations | ||||
Public toilet & patient's ba throom are cle an. | ||||
Water dispense r is clean, cu ps are properl y kept in dedi cated containe r | ||||
Staff appearan ce is neat and tidy (use app ropriate unifo rms) | ||||
Staff fingerna ils are clean & trimmed | ||||
Crash cart / e -trolley clean and free from dust. |
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Semi-Restricte d Zone: Staff must cha nge into theat re clothes and shoes before entering this area | ||||
Restricted Zon e; Staff working in this area s hould change i nto theatre cl othes, should wear mask and gown, and wher e necessary sh ould wear ster ile gloves. | ||||
Room temperatu re must be mai ntain between 18 - 21 degree Celsius at al l times | ||||
YES | NO | NA | REMARKS | |
Humidity shoul d maintained a t 50% - 60% | ||||
Instruments / equipment's ar e well stored, clean and cle ar from dust | ||||
Exam table / b ed and procedu re trolley are clean and no stain | ||||
CSSD / sterile items are kep t in clean and close storage free from dus t. |
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| All sterile instruments must be stored in clean containers, dedicated area and are distant from floor (20cm), ceiling (40cm) and side wall (5cm). Temperature within 22 - 26 degree Celsius and humidity is <60% | ||||
| Instrument packaging integrity: Sterile instrument / equipment must be wrapped | ||||
| Each package is checked for expire date and wrapper integrity prior to opening |
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
High touch surf ace (e.g., bedr ails, call bell , cardiac table ) are cleaned a nd disinfected regularly) | ||||
YES | NO | NA | REMARKS | |
Curtain are cle an and changed as schedule (he ck last date ch anged) |
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Biohazard spillage kit complete with items and available (housekeeping) | ||||
| Housekeeping staff staff aware of cleaning solution admixing policy | ||||
| Housekeeping cart is clean and in good condition |
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Janitor room is clean, neat and no food or any personal belongings kept in. | ||||
| Dirty utility / sluice room are clean, neat and tidy | ||||
| Macerators clean and functioning. | ||||
| Chemicals for cleaning are properly labelled and stored at designated area (housekeeping) |
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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.