Microbiology supervisors checklist
To be verified at least once in 30 days by the supervisor.
Sign in to Google to save your progress. Learn more
Date and Time of verification *
MM
/
DD
/
YYYY
Time
:
IQC *
YES
NO
No tests today
Not Applicable
Virotrol for HIV
Virotrol for HBsAg
Virotrol for HCV
Virotrol for HBC Ag
IQC for AFB
IQC for Gram Stain
IQC for Blood agar
IQC for Chocolate agar
IQC for Indole test / Peptone water
IQC for Mac Conkey agar
IQC for Nutrient agar
IQC for Sabouraud’s Dextrose agar
IQC for Triple sugar iron agar
IQC for Bile esculin agar
IQC for Simmon’s citrate agar
IQC for Muller Hinton agar
IQC for Mannitol motility medium
IQC for MR/VP
IQC for Phenyl pyruvic acid
IQC for Christensen’s urea agar
Split sample or prev day sample done for all tests with no IQC
Updated all QC reports in Unity Realtime
Filed, signed hard copy of all the QCs
Any errors noted in Unity Realtime QC today
Corrective action for the error done
Clear selection
EQAS *
YES
NO
Not Applicable
Monthly Microbiology EQAS
ILC done for parameters that do not have EQAS
EQAS reports verified
Corrective action Filed
Reagents *
Yes
No
Not Applicable
Verified for Near expiry
Verified sufficient stock for gram's stain
Verified sufficient stock for ZN Stain stain
Verified sufficient stock for HIV Cards
Verified sufficient stock for HBsAg Cards
Verified sufficient stock for HCV Cards
Verified sufficient stock for Dengu Cards
Verified sufficient stock for all Culture Media
<1Month exp items are returned
Reagent loss register is updated
Maintenance *
YES
NO
Not Applicable
Daily & Weekly Maintenance of Balance(BL2200H) is updated
Daily & Weekly Maintenance of Balance(ATY224) is updated
Daily & Weekly Maintenance VIDAS is updated
Daily & Weekly Maintenance of VITEK(E-079) is updated
Daily & Weekly Maintenance of Microscope(E-005) is updated
Daily & Weekly Maintenance of Incubator (E-022) is updated
Daily & Weekly Maintenance of Incubator (E-065) is updated
Daily & Weekly Maintenance of Safty Cabinat (E-031) is updated
Daily & Weekly Maintenance of Safty Cabinat (E-073) is updated
Daily & Weekly Maintenance of Safty cabinate (E-074) is updated
Daily & Weekly Maintenance of Hot Air Oven (E-024) is updated
Daily & Weekly Maintenance of Hot Air Oven (E-020) is updated
Records *
Complete up to the time of inspection
Complete up to yesterday
Not updated
Not Applicable
CRITICAL VALUE REGISTER
STOCK REGISTER/INVENTORY
ROOM TEMP & HYGROMETER
IQC REGISTER
IQC-RCA CA REGISTER
EQAS REGISTER
TAT REGISTER
DAILY MAINTENANCE REGISTER
REPEAT TEST REGISTER
HANDOVER REGISTER
INCIDENT/ACCIDENT RECORD REGISTER
TEST LOST REGISTER
COMMUNICATION REGISTER
ALTERED REPORT REGISTER
EQUIPMENT PRINTOUTS
MONTHLY STATISTIC REGISTER
EQUIPMENT USAGE REGISTER
LOT VERIFICATION REGISTER
EQUIPMENT TEMPERATURE MONITORING REGISTER
SAMPLE STORAGE & DISPOSAL REGISTER
POSITIVE SERUM SAMPLE REGISTER
Telephone Call Log Register
IQC Preparation and Utilization Register
Equipment Register
Equipment CAL / PM Schedule
Employee Competency Evaluation File
Departmental Internal Training Register
MSDS File
BMW *
Yes
No
Not Applicable
Prepared Hypo fresh today
Emptied waste bins today
Seggreation has errors
Filling of Machine waste container with con Hypo
House Keeping *
Yes
No
Not Applicable
Cleaned the top of Equipments by staff
Cleaned floor by PHS staff
Cleaned Workdesk by the PHS staff
Each work area cleaned by the staff in the area
Each persons area is neat and tidy
SPILL KIT *
Yes
No
Not Applicable
Spill Kit- Full Sleeve Disposable Gown- Expiry >3 months
Head Cap - Expiry >3 months
Face Mask -Expiry >3 months
Google - Expiry >3 months
Shoe Cover - Expiry >3 months
Disposable Gloves - Expiry >3 months
Potassium peroxomonosulphate - Expiry >3 months
Scoope
Wooden Spatula
Dust Pan
Hand Sweep Brush
Garbage Bag: Yellow, Red. Black
FIRST AID KIT *
Yes
No
Not Applicable
Spot bandage (Exp.> 3 months)
Cotton I. P. (Exp.> 3 months)
Sterile Gauze Swab (Exp.> 3 months)
Povidone iodine solution (Exp.> 3 months)
Paracetamol 650 mg Tab (Exp.> 3 months)
Eye wash cup
Scissors
Sterile blood lancet (Exp.> 3 months)
Alcohol swab (Exp.> 3 months)
Updated by (Name & Emp ID) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Believers Church Medical College Hospital.

Does this form look suspicious? Report