Nursing Home Infection Control Log
This log is to be used daily by staff to record all infection-related incidents within the facility. It should be filled out with accuracy to ensure proper tracking and management of infectious diseases.
Resident Information
Resident Name | Room No. | Age | Pre-existing Conditions |
|---|
[Resident Name] | 101 | 78 | Diabetes, Hypertension |
| | | |
| | | |
Incident Details
Time of Observation | Symptoms | Suspected Infection | Action Taken | Reported to (Name/Position) |
|---|
08:45 AM | Fever, cough | Yes - Flu | Isolation, Administered Antipyretic | Nurse Supervisor - [Name] |
| | | | |
| | | | |
Staff Health Screening
Staff | Position | Time In | Symptom Check | Temperature Check | Fit for Work |
|---|
[Name] | Nurse | 07:00 AM | No Symptoms | 98.6°F | Yes |
| | | | | |
| | | | | |
Sanitization Records
Area | Time | Staff Responsible |
|---|
Resident Rooms | 09:00 AM | [Name] |
| | |
| | |
Checked By: [Your Name]
Date: [Month, Day, Year]
[Your Company Name] commits to the health and safety of our residents and staff. This log is an essential part of our infection control measures. Please ensure all sections are completed daily.
Nursing Home Templates @ Template.net
