Scribd Logo
Upload

Welcome to Scribd!

  • 2016 Best Infection Entry Form

    Uploaded by

    JUSTIN
    6 views1 page
    The document appears to be an entry form for a hospital best practices awards program focusing on infection prevention and control. It requests information such as the hospital name, address, contact details, and categories they are entering. It also asks which member organization they belong to and special awards they will join. Finally, it requests contact information for the infection control committee head, nurse, and members who are submitting the entry form.

    Original Description:

    1

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document appears to be an entry form for a hospital best practices awards program focusing on infection prevention and control. It requests information such as the hospital name, address, contact details, and categories they are entering. It also asks which member organization they belong to and special awards they will join. Finally, it requests contact information for the infection control committee head, nurse, and members who are submitting the entry form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views1 page

    2016 Best Infection Entry Form

    Uploaded by

    JUSTIN
    The document appears to be an entry form for a hospital best practices awards program focusing on infection prevention and control. It requests information such as the hospital name, address, contact details, and categories they are entering. It also asks which member organization they belong to and special awards they will join. Finally, it requests contact information for the infection control committee head, nurse, and members who are submitting the entry form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Infection Prevention and Control: Our Commitment, Your Well-being

    HOSPITAL BEST PRACTICES


    IN INFECTION PREVENTION AND CONTROL AWARDS YEAR III

    ENTRY FORM
    Name of the Hospital: _______________________________________________________________________________
    Categories (please check): Level 3
    [ ]
    Level 1
    [ ]
    Level 2
    [ ]
    Other Healthcare Facilities
    [ ]
    Address
    : _______________________________________________________________________________
    _________________________________________________________________________________________________________
    Telephone Number : __________________
    Email address:_______________________________________
    Member Organization (please check):
    [ ] PHA [ ] PHICS
    [ ] PHAPI
    [ ] PCHA
    [ ] AHA
    Will join (please check):
    [ ] Over All Winners
    [ ] Special Award
    [
    [
    [
    [
    [
    [
    [

    ] Best in Hand Hygiene


    ] Best in Environmental Cleaning and Decontamination
    ] Best in Management of Infection Prevention Among Healthcare Workers
    ] Best in Healthcare Waste Management
    ] Best in Isolation Precaution Management
    ] Best in Outbreak Management
    ] Best in Surveillance of antibiotic resistance

    Infection Control Committee Head: _____________________________________________________________


    Contact No.: _______________________
    Email Address:_______________________________________
    Infection Control Nurse: __________________________________________________________________________
    Contact No. : ______________________
    Email Address: ______________________________________
    ICC Member/s:
    Name
    Designation
    ________________________________________
    _____________________________________
    ________________________________________
    _____________________________________
    ________________________________________
    _____________________________________
    ________________________________________
    _____________________________________
    Submitted by:
    _______________________________________________
    Name and Signature of Hospital Director/
    Chief of Hospital/Hospital Administrator

    _________________________________________
    Date of Submission

    You might also like