Cleaning Management Audit Report Date audited:
12/10/2014
Location:
Sample Sample Sample Sample
Client name:
Your practice
Auditor:
Yourself
Accompanied by:
Staff member
Additional info:
Rooms: 1 minor surgery suite (inc clean utility & dirty utility) 3 consulting, 2 treatment rooms, 1 minor surgery, clean utility, dirty utility, office areas, staff & public toilets, staff kitchen.
General Practice surgery town Post Code
Section
% Compliance
Governance and Documentary Evidence of effective cleaning practices
61 %
Healthcare cleaning training
33%
Hand hygiene
71%
Use of Personal Protective Equipment for Cleaning
55%
Waste Management
82%
Spillage Management
90%
Minor surgery room
48%
Treatment Room 1
77 %
Treatment Room 2
92 %
Consulting Room 1
47 %
Consulting Room 2
51 %
Consulting Room 3
82 %
Dirty Utility
82%
Clean Utility
77%
Public WC & baby changing
74%
Staff WC & shower
52%
Staff kitchen
36%
General office
60%
Reception area
92 %
Domestic/Housekeeping Room
84%
Standard assessment of cleanliness of the environment
40 %
Total
61 %
Copyright IPC Management (Holdings) Ltd Š 2005–2014 Template: Primary Care with Minor Surgery (AT017)
Date Approved: 13/05/2014
ICAT Audit Tool Vrs 2.0 Page 1 of 3