Template

Isolation Precautions Checklist

by stefani anderson, from the Community

20+

This isolation precautions checklist helps healthcare teams verify correct signage on isolation rooms, confirm the type of isolation implemented (airborne, droplet, contact, enhanced droplet), and ensure appropriate PPE and charting practices are followed. It can be used across hospital units including Med-Surg, ARU, Tele, OB-Peds, ICU, and ED to support consistent infection control and compliance with facility policies.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
PPE Audit Checklist for Contact and Droplet Precautions
Conduct a comprehensive PPE audit aligned with contact and droplet isolation precautions. This checklist guides observers through donning and doffing steps, hand hygiene, proper mask and eye protection use, glove removal technique, gown handling, and disposal or sanitizing of reusable items. Record roles and locations, verify compliance behaviors, and capture issues with corrective actions to improve staff training and patient safety.
by Melissa Therrien, from the Community
Downloads: 30+
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Template
PPE Audit Template for Healthcare Settings
Use this PPE audit template to evaluate safe and compliant PPE use in healthcare environments. Capture observation context, staff roles such as physicians, nurses, allied health, and EVS, and the required precautions including contact, droplet, droplet plus, and airborne. Verify hand hygiene before and after PPE, correct sequence of gown, gloves, mask, and eye protection, and proper donning and doffing. Record universal precautions, potential contamination sources like phones or pagers, missed hand hygiene, and any noncompliance. Customize to your facility policies and confirm suitability with professional guidance.
by Meghan Engbretson, from the Community
Downloads: 10+
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Template
Transmission Based Precautions Checklist
This Transmission Based Precautions checklist helps healthcare teams implement and audit infection control for patients requiring isolation. It covers airborne, contact, and droplet precautions, including placement in appropriate rooms, door and signage checks, and PPE availability such as N95 or P2 masks, gowns, gloves, and level 2 or 3 masks. Staff can verify correct donning and doffing, ensure hand hygiene with alcohol based hand rub is accessible, and confirm documentation like infectious disease notes or safety alerts. The template prompts checks for patient masking when leaving rooms, availability of disinfectant wipes, correct clinical waste disposal, cleaning procedures, and whether patient information leaflets were provided.
by Curt Werner, from the Community
Downloads: 0
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Template
High Risk Isolation Audit Checklist
This high risk isolation audit checklist helps teams verify hazardous energy controls and validate isolation effectiveness on complex worksites. It covers identifying energy sources, selecting proper isolation methods, testing single and multiple isolation points, and documenting TRA and permit requirements. The template supports assigning an isolation coordinator, communicating activities to nearby workers, and ensuring all tools are cleared and personnel are safe before re energising equipment. Use it to improve compliance and reduce risk during electrical, mechanical, and commissioning tasks.
by JUSTINE YOUL, from the Community
Downloads: 10+
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PPE Audit Checklist for Contact and Droplet Precautions

Conduct a comprehensive PPE audit aligned with contact and droplet isolation precautions. This checklist guides observers through donning and doffing steps, hand hygiene, proper mask and eye protection use, glove removal technique, gown handling, and disposal or sanitizing of reusable items. Record roles and locations, verify compliance behaviors, and capture issues with corrective actions to improve staff training and patient safety.

by Melissa Therrien, from the Community

30+

Get

Template

PPE Audit Template for Healthcare Settings

Use this PPE audit template to evaluate safe and compliant PPE use in healthcare environments. Capture observation context, staff roles such as physicians, nurses, allied health, and EVS, and the required precautions including contact, droplet, droplet plus, and airborne. Verify hand hygiene before and after PPE, correct sequence of gown, gloves, mask, and eye protection, and proper donning and doffing. Record universal precautions, potential contamination sources like phones or pagers, missed hand hygiene, and any noncompliance. Customize to your facility policies and confirm suitability with professional guidance.

by Meghan Engbretson, from the Community

10+

Get

Template

Transmission Based Precautions Checklist

This Transmission Based Precautions checklist helps healthcare teams implement and audit infection control for patients requiring isolation. It covers airborne, contact, and droplet precautions, including placement in appropriate rooms, door and signage checks, and PPE availability such as N95 or P2 masks, gowns, gloves, and level 2 or 3 masks. Staff can verify correct donning and doffing, ensure hand hygiene with alcohol based hand rub is accessible, and confirm documentation like infectious disease notes or safety alerts. The template prompts checks for patient masking when leaving rooms, availability of disinfectant wipes, correct clinical waste disposal, cleaning procedures, and whether patient information leaflets were provided.

by Curt Werner, from the Community

Get

Template

High Risk Isolation Audit Checklist

This high risk isolation audit checklist helps teams verify hazardous energy controls and validate isolation effectiveness on complex worksites. It covers identifying energy sources, selecting proper isolation methods, testing single and multiple isolation points, and documenting TRA and permit requirements. The template supports assigning an isolation coordinator, communicating activities to nearby workers, and ensuring all tools are cleared and personnel are safe before re energising equipment. Use it to improve compliance and reduce risk during electrical, mechanical, and commissioning tasks.

by JUSTINE YOUL, from the Community

10+

Get

Isolation Precautions Checklist

About author

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PPE Audit Checklist for Contact and Droplet Precautions

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Transmission Based Precautions Checklist

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PPE Audit Checklist for Contact and Droplet Precautions

PPE Audit Template for Healthcare Settings

Transmission Based Precautions Checklist

High Risk Isolation Audit Checklist