Hand Hygiene Observation
Please observe the employee performing hand hygiene and answer the questions below.
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Email *
Your First Name *
Your Last Name *
Caregiver's First Name *
Caregiver's Last Name *
Date of Observation *
1. Washed hands before client care *
2. Washed hands after client care *
3. Washed hands before preparing food or fetching liquids to drink for client *
4. Washed hands after client care and before preparing food or fetching liquids for client *
5. Washed hands after touching environmental surfaces in the immediate vicinity of the client *
6. Washed hands after touching client's linens or bedding *
7. Washed hands after taking vital signs, performing an examination, repositioning client *
8. Washed hands with soap and water when hands were visibly soiled (Should not use alcohol-based hand cleanser for visibly soiled hands) *
9. Washed hands before putting on gloves *
10. Washed hands after glove removal *
11. Washed hands before giving medications *
12. Washed hands before and after assisting client with mobility *
13. Caregiver used sufficient volume of soap to cover surfaces of the hands and fingers, scrubbing with friction at least 20 seconds before rinsing *
14. Caregiver turned off water without re-contaminating their hands *
15. Caregiver applied sufficient volume of alcohol-based cleanser to cover all surfaces of the hand and fingers, rubbing the hands and fingers until dry (about 15-25 seconds) *
16. Liquid hand sanitizer contains at least 60% alcohol *
17. Washed hands after assisting client with toileting *
18. Washed hands before contact with body fluids or mucous membranes *
19. Caregiver provided education to client *
20. Caregiver provided education to client's family *
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