Enviromental Audit Report
Add Header
ENVIROMENTAL AUDIT
INFECTION CONTROL
Department / Area:
- OPERATION THEATER
Date Assessment:
21/02/2025
HAND HYGIENE
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Adequate facilities for hand hygiene are available and are equipped with soap and hand towel | ||||
| Alcohol - based hand rub available at point of care | ||||
| All hand rub must be labeled with date of opening | ||||
| Staff demonstrate proper hand hygiene technique |
MEDICATION REFRIGERATOR
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Medication fr idge is clean and only use d for medicat ions | ||||
Sterile solut ions are date d when opened and dispose within 24 hou rs | ||||
Temperature o f the fridge must be check ed daily and recorded (2 - 8 degree Cel sius). Action s taken if fr idge temperat ure is out of range | Temperature is within range. However, frid ge in OR 2 was found not clo sed properly. (Picture 1) | |||
YES | NO | NA | REMARKS | |
Medication is labeled with date and tim e of opening |
ISOLATION PRECAUTION
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Correct isolation signage is used to indicate the isolation room | ||||
| Isolation trolley must be equipped with PPE and must be kept clean and tody | ||||
| Door is kept closed at all times | ||||
| Negative pressure room should be check for its function daily and recorded |
LINEN
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Clean linen distributed to department units on clean, covered carts | ||||
| Clean linen is stored in clean utility room or clean cabinet, cabinet doors must be kept closed at all times and only accessible to staff. | ||||
| Linen room are for the storage of clean linen items only and not used for storage of any other equipment. | ||||
| Soiled linen is segregated in appropriate color coded bag and kept in sluice / dirty room | ||||
| Linen bags not overfilled & easy to ensure | ||||
| Linen skip is clean and covered |
SHARP & WASTE MANAGEMENT
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
General waste and clinical waste are se gregated | ||||
Sharp bin are assembled co rrectly, and are closed af ter it is 3/4 full | ||||
Clinical wast e bins are no t over filled | ||||
Sharp contain ers are safel y stored in a designated a rea and do no present a ri sk to patient s/ visitors. |
GENERAL
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
Counter clean , neat & tidy , free from f luid & blood stain | ||||
YES | NO | NA | REMARKS | |
Staff Room / pantry area a re clean & ti dy | - Freezer tr ay was found dirty. (Pic ture 2), Dra wer and pant ry in staff pantry was f ound untidy (Picture 3) | |||
All sterile i nstruments / items must be stored in cl ean container s, dedicated area, and mus t be wrapped free from sta in & cob webs . | ||||
Waiting area (OPD 5, OPD 8 ) clean & tid y. | ||||
All equipment are clean an d free of sta ins (e.g: GA machine, infu sion pumps an d syringe pum ps, crash car t, trolley) a nd properly s tored. | ||||
Floors, wall clean and fre e from visibl e dirt & stai ns. | ||||
Ceilings free from stains, holes and pe netrations | ||||
Public toilet & patient's bathroom are clean. | ||||
Water dispens er is clean, cups are prop erly kept in dedicated con tainer | ||||
Staff appeara nce is neat a nd tidy (use appropriate u niforms) | ||||
Staff fingern ails are clea n & trimmed | ||||
Crash cart / e-trolley cle an and free f rom dust. |
OPERATING THEATRE - LAYOUT
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 | ||||
Humidity shoul d maintained a t 50% - 60% | ||||
Instruments / equipment's ar e well stored, clean and cle ar from dust | - Brown boxe s was found in OR 2 layi ng down on t he floor (Pi cture 4), - Fire extingu isher (ABC & C02), hand sanitizer di spenser and trolley infr ont of steri le room loca ted near OR 5 was found dusty (Pictu re 5,6,7,&8) | |||
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. | Sterile room racks was f ound dusty ( Picture 9) |
CSSD
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
All sterile in struments must be stored in clean containe rs, dedicated area and are d istant from fl oor (20cm), ce iling (40cm) a nd side wall ( 5cm). Temperat ure within 22 - 26 degree Ce lsius and humi dity is <60% | ||||
Instrument pac kaging integri ty: Sterile instru ment / equipme nt must be wra pped | ||||
Each package i s checked for expire date an d wrapper inte grity prior to opening |
PATIENT'S ROOM
YES | NO | NA | REMARKS | |
|---|---|---|---|---|
High touch sur face (e.g., be drails, call b ell, cardiac t able) are clea ned and disin fected regular ly) | ||||
YES | NO | NA | REMARKS | |
Curtain are cl ean and change d as schedule (heck last dat e changed) |
HOUSEKEEPING
| YES | NO | NA | REMARKS | |
|---|---|---|---|---|
| Bio-hazard 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 |
UTILITIES ROOM
| 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 | Extra dichlocept stocks was stored under sink of dirty utility room (Picture 10) | |||
| Macerators clean and functioning. | ||||
| Chemicals for cleaning are properly labelled and stored at designated area (housekeeping) |
Audited by:
- NURHANISAH BINTI HERMAN
Acknowledge by:
- KHAIRULNIZAM MOHAYAN
Add Header
Add Header
Add Header
Add Header
Add Header
Add Header
Add Header
Add Header
Add Header
About this template
Related templates
Energy Audit Report
Energy Audit Report Template is used to assess the energy consumption of a company and how they can save more energy by optimizing the right items. In addition, you can easily modify the fields according to your immediate needs.
Land Appraisal Report Template
Assess a property by using this Land Appraisal Report Template in order to determine its value on the market. This PDF template is simple but shows all necessary information when appraising a property.
Menu Compliance Audit Report
Menu Compliance Audit Report Sample provides you an effective way to report your findings each time you carry out menu compliance auditing. With Menu Compliance Audit Report PDF Template, health inspectors can easily create customized PDF reports.
Daily Safety Inspection Report
Daily Safety Inspection Report Sample is an audit report, which is obviously crucial for any company to track the health and well-being of the employees. The fields in the template include equipment standards of workers.
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.