KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬

KING FAISAL HOSPITAL ‫مستشفى الملك فيصل‬
Scope of risk (Housekeeping) Checklist
WARD/UNIT: ___________________________ DATE: ____________________

LEGEND: PT = Preparation Tool INT = Interview OBS = Observation MR = Medical Record O/I = Observation/Interview DR=Document
Review NM =Not met (Score = 0 when < 50 % compliance) PM = Partially met (Score=1 ≥ 50 to < 80 % compliance) FM = Fully met( Score= 2 when
≥ 80 % compliance) NA = Not applicable(Cancelled Score )

Points of measurement PT RESULT COMMENTS

NM PM FM NA
0 1 2
1- An orientation and training program for all housekeeping staff has been DR
implemented with documentation.
2- The overall appearance of the facility is clean and sanitary. OBS
3- Cleansers and disinfectants are mixed, labeled and used correctly in the proper DR
concentration, date & time indicated on containers.
4- Separate Color coded equipment is used for "clean" and "dirty" areas and for OBS
critical areas.
5- Safety policies and procedures are followed including use of signs, ropes and DR
cones.
6- Hand soap, antiseptic soap, disinfectants, paper towels, toilet paper and other OBS
supplies are provided throughout the facility.
7- Mops are changed and laundered daily. OBS
8- Hospital external surroundings are clean and free of litter and nuisances. OBS
9- Employee housing accommodation is clean, sanitary and well maintained. OBS
10- MSDS are available to all staff DR
11- Evacuation plan map is posted indicating evacuation OBS
route.
12- PEST CONTROL

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 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬
KING FAISAL HOSPITAL ‫مستشفى الملك فيصل‬
Scope of risk (Housekeeping) Checklist
 Pest control programs are carried out as per schedule. DR
 All pesticides used in the facility are labeled, applied and stored in DR
accordance with the current standards. MSDS are given
 Pest areas of concern are identified and reported promptly. DR
 Inspection of all incoming materials is checked to prevent entrance of pests OBS
into the facility.
 Maintenance requests are submitted and corrective actions are taken to DR
control or eliminate pests from the facility.
13- SOLID WASTE DISPOSAL
 Infectious waste (lab. cultures and stools, blood, blood products and body OBS
fluids, isolation room wastes, used and unused sharps, pathology wastes) are
segregated from regular wastes and are clearly identified.
 Clean linered waste containers are provided where ever needed. DR
 Handling, storing, transport and disposal of solid wastes, including hazardous OBS
wastes are carried out in a safe and sanitary manner.
 Used and unused sharps (needles, syringes, lancets, scalpels, razor blades) are OBS
disposed of in a safe and sanitary manner.
 Laboratory wastes are autoclaved under prescribed autoclaves using biological OBS
indicators.
 Any needle stick/sharp injury is reported promptly and corrective actions DR
documented.

NAME&SIGNATURE OF ASSESSOR:__________________________ NAME&SIGNATURE OF HEAD DEPART:______________________________

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