Contact Precautions Signage Checklist
Use this checklist to assess the presence, condition, and compliance of contact precautions signage in healthcare areas.
Facility Name
*
Unit or Department
*
Room Number or Area Assessed
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Full Name
*
First Name
Last Name
Contact Precautions Signage Compliance
*
Rows
Signage Present
Signage Clearly Visible
Signage in Good Condition
Signage Follows Standard Protocol
Entrance to Room/Area
1
2
3
4
Inside Room/Area
5
6
7
8
Is additional signage needed in this area?
*
Yes
No
Overall visibility and clarity of signage
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Are instructions for visitors and staff included on the signage?
*
Yes
No
Partially
Please rate overall compliance with contact precautions signage protocols.
*
1
2
3
4
5
Comments or Corrective Actions Needed
Submit Checklist
Should be Empty: