Monthly Nursing Compliance Checklist
Complete this checklist to verify monthly compliance with nursing standards and protocols.
Staff Full Name
*
First Name
Last Name
Position/Title
*
Department/Unit
*
Month and Year of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Nursing Compliance Checklist
*
Rows
Compliant
Non-Compliant
Not Applicable
Hand hygiene protocols followed
1
2
3
Medication administration documented accurately
4
5
6
Patient identification procedures followed
7
8
9
Use of personal protective equipment (PPE)
10
11
12
Patient safety checks completed
13
14
15
Proper disposal of medical waste
16
17
18
Accurate and timely charting
19
20
21
Infection control measures observed
22
23
24
Equipment sanitized after use
25
26
27
Fall risk assessments completed
28
29
30
Have any incidents or compliance concerns occurred this month?
*
No incidents or concerns
Yes, incidents or concerns occurred (please describe below)
If yes, please provide details of incidents or compliance concerns:
Additional comments or suggestions for improvement:
Supervisor Name (if applicable)
Staff Signature
*
Submit Checklist
Submit Checklist
Should be Empty: