INFECTION CONTROL CHECKLIST One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlySurveillancePerforms targeted surveillance(Required) 1 2 3 4 Outbreak investigations(Required) 1 2 3 4 Collaboration with Infection Control Committee(Required) 1 2 3 4 Performance improvement projects related in communicable diseases(Required) 1 2 3 4 Collects, monitors, and maintains data using facility HER(Required) 1 2 3 4 Utilize Center for Disease Control (CDC)(Required) 1 2 3 4 Infection criteria(Required) 1 2 3 4 TB, AIDS(Required) 1 2 3 4 Documentation and investigation techniques(Required) 1 2 3 4 Rounds of hospital units(Required) 1 2 3 4 Case definition, and other related patient care issues(Required) 1 2 3 4 Monitor infection control practices(Required) 1 2 3 4 Nosocomial infections or AHIs, MRSAs(Required) 1 2 3 4 Tracing the possible sources of infection or transmission of microorganisms(Required) 1 2 3 4 Identification of ProblemsRegularly meet with the hospital Epidemiologist(Required) 1 2 3 4 Risk reduction among patients, facility staff, volunteers, students, and visitors(Required) 1 2 3 4 Understand the transmission and break of infections(Required) 1 2 3 4 Identification of epidemiologically important issues for Infection Control Committee(Required) 1 2 3 4 Hospital Epidemiologist, and AdministrationDesign COA including Surveillance, Outbreak Investigations, and Performance Improvement Projects(Required) 1 2 3 4 Communicable diseases reporting as required by the state and the local health authority(Required) 1 2 3 4 Compliance with federal and state laws regarding medical wastes, chemicals in the workplace, infectious disease exposures(Required) 1 2 3 4 OSHA NIOSH standards(Required) 1 2 3 4 Blood borne pathogens and respiratory pathogens(Required) 1 2 3 4 Chart review(Required) 1 2 3 4 Policies and ProceduresInfection Control policies associated with infection(Required) 1 2 3 4 Staff practices associated with infection contol(Required) 1 2 3 4 Professional guidelines (CDC, APIC, etc.)(Required) 1 2 3 4 The Joint Commission guidelines on infection Control(Required) 1 2 3 4 Infection Control Plan to reflect and meet any required changes(Required) 1 2 3 4 CoordinationActs as department liaison for Infection Control Department(Required) 1 2 3 4 Act as consultant for the facility Infection Control activities(Required) 1 2 3 4 Interdepartment and personnel coordination on risk reduction, transmission and improved infection control practices(Required) 1 2 3 4 Provide coordinated services to patients for the improvement of overall(Required) 1 2 3 4 Patient care(Required) 1 2 3 4 EducationIn-services of all and current employees on Infection Control(Required) 1 2 3 4 Orientation programs of new employees on Infection Control(Required) 1 2 3 4 Infection Control techniques and Policies and Procedures(Required) 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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