Infection Control Assessment
Please complete the following assessment to ensure proper infection control measures are in place.
Assessor's Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Assessment
*
Are standard infection control procedures being followed?
*
Yes
No
Partially
Are personal protective equipment (PPE) available and used properly?
*
Yes
No
Partially
Is hand hygiene practiced consistently?
*
Yes
No
Partially
Are surfaces and equipment properly disinfected?
*
Yes
No
Partially
Are waste disposal procedures followed correctly?
*
Yes
No
Partially
Additional comments or observations
*
Submit
Should be Empty: