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Infection control risk assessment template

Infection control risk assessment template

Document and address infection risks effectively with this template. It includes key sections for high-risk areas, pathogen monitoring, and compliance tracking.

Use this template
or download pdf
Infection control risk assessment template

Document and address infection risks effectively with this template. It includes key sections for high-risk areas, pathogen monitoring, and compliance tracking.

Use this template
or download pdf

About the Infection control risk assessment template

This infection control risk assessment template is your go-to tool to assess, record, and manage infection risks efficiently. Designed for industries where workplace hygiene is critical, from healthcare to hospitality, this template helps you conduct thorough assessments that ensure each facility is up to par with safety standards. With this template, you can simplify your inspection process, monitor compliance, and give detailed feedback to your team, all in one place.

A step-by-step guide to using the infection control risk assessment template

Here’s how to use the template effectively:

  1. Set up and customize. Begin by opening the template in Lumiform’s app and customize it to suit your facility’s specific needs. Feel free to add sections for high-risk areas, specific infection types, or department-specific protocols.
  2. Assign roles and responsibilities. Delegate sections of the assessment to different team members. For example, you can assign cleaning staff to inspect surfaces and equipment or ask health officers to monitor hand hygiene practices.
  3. Conduct assessments with frontline staff. Equip your frontline workers with the mobile template to perform checks in real time. Whether they’re in patient areas, kitchens, or entry points, staff can record observations instantly, capturing essential data directly into the system.
  4. Track and manage actions. Use the app’s task management feature to track areas that need immediate attention. If there’s a recurring issue—like low PPE stock—set up an alert for quick follow-up. This proactive management allows you to address risks before they escalate.
  5. Analyze and review. After completing assessments, use Lumiform’s analytics to review trends, assess compliance, and adjust protocols. The data helps you make informed decisions and continuously improve your infection control strategy

Customizing the infection control risk assessment template

To make the infection control risk assessment template fit your facility, you can add department-specific fields. For example, you can add fields related to high-risk areas like ICU, surgery, and patient wards, with checkpoints such as ventilator cleaning and storage monitoring.

Another option is to incorporate infection types to monitor based on your risk profile. For example, you might include questions about preventing common pathogens like MRSA, C. diff, or tuberculosis. This allows for precise assessments and quick action when any of these risks emerge.

You might also include compliance standards that your facility needs to follow, like OSHA or CDC guidelines. This way, inspections not only meet your internal standards but also align with regulatory requirements.

Download Lumiform’s infection control risk assessment template today

With this risk assessment template, you’re equipped to identify and tackle infection risks with a tool tailored for your facility. Streamline each inspection, track compliance, and document findings all in one form. With features that allow you to customize sections, add compliance standards, and assign specific tasks, this template is ready to support thorough infection control practices for your facility.

Related categories

  • Health and safety management templates
  • Health care templates
  • Risk assessment templates
  • Safety templates
Preview of the template
Page 1
Facility Information
Facility Name
Facility Type (hospital, clinic, etc.)
geolocation!!!
Contact Person
Phone Number
Infection Control Policies
Does the facility have written infection control policies and procedures?
Are infection control policies regularly reviewed and updated?
Are all staff trained on infection control policies and procedures?
Is there a designated Infection Control Coordinator?
Hand Hygiene
Are hand hygiene facilities (sinks, soap, paper towels) available in patient care areas?
Are alcohol-based hand rubs available in patient care areas?
Do staff receive regular training on proper hand hygiene techniques?
Is hand hygiene compliance monitored and feedback provided to staff?
Personal Protective Equipment (PPE)
Is appropriate PPE (gloves, gowns, masks, etc.) available for staff use?
Are staff trained on the proper use, donning, and doffing of PPE?
Is PPE usage monitored and is feedback provided to staff?
Environmental Cleaning
Are written cleaning and disinfection protocols in place?
Are staff trained on proper cleaning and disinfection techniques?
Is regular monitoring and feedback provided on cleaning practices?
Sharps Management
Are sharps containers available and located close to the point of use?
Are staff trained on proper sharps handling and disposal?
Is sharps handling and disposal monitored and feedback provided?
Infectious Waste Management
Are there written procedures for handling and disposing of infectious waste?
Are staff trained on proper infectious waste management procedures?
Is infectious waste management monitored and feedback provided?
Outbreak Preparedness
Does the facility have an outbreak response plan?
Are staff trained on outbreak investigation and response procedures?
Are outbreak response drills and simulations conducted regularly?

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

Infection control guide: Best practices and strategiesPersonal protective equipment (PPE): A comprehensive guideLegionella risk assessment: Your essential guide
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Template collections

See comprehensive collections of best practice templates related to this topic.

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Use cases

Check out how the Lumiform software can be utilized for related use cases.

Risk assessment softwareFacility management softwareSafety inspection app
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Other resources

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5 types of incident reportsHow to evaluate compliance measuresHow to perform safety inspections5 ways workflow automation streamlines healthcare administration

Frequently asked questions

What are some common infection risks in healthcare settings that are often overlooked?

Some of the more overlooked infection risks in healthcare settings include contaminated surfaces in non-patient areas, inadequate disinfection of shared equipment (like keyboards or phones), and improper handling of linens. Even items like pens or elevator buttons can harbor pathogens.

How can we identify high-risk areas for infection within our facility?

Start by reviewing patient traffic patterns, cleaning protocols, and ventilation systems. High-risk areas usually have high patient turnover, involve invasive procedures, or serve immunocompromised individuals—such as ICU rooms, surgical areas, and emergency rooms.

What should we do if we detect a recurring infection risk in a specific area?

If you find repeated infection risks, begin with a root-cause analysis to determine why. Evaluate whether cleaning schedules, protocols, or staff practices are sufficient, and consider reinforcing these with additional training or resources. For persistent issues, you might implement more frequent spot-checks or even temporary restrictions.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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