COVID-19 Point Prevalence Survey Log

Facility-wide inspection log for documenting COVID-19 point prevalence testing rounds during an outbreak in a skilled nursing facility, including residents and staff tested, results, follow-up actions, and compliance documentation.

Inspection Details

• Facility name
• Survey date and time
• Outbreak or suspected outbreak identified
• Testing round identifier
  Enter the point prevalence survey round number or event identifier.

Population Tested

• Residents eligible for testing
• Residents tested
• Staff eligible for testing
• Staff tested
• All available residents included in the survey

Test Administration and Results

• Test type used
• Tests administered
• Positive results
• Negative results
• Indeterminate or invalid results
• Results reported to infection prevention leadership

Infection Control Follow-Up

• Positive cases isolated or cohorted per facility protocol
• Exposure notifications completed
• Contact tracing initiated for positive or exposed individuals
• Additional testing or repeat testing scheduled

Documentation and Sign-Off

• Specimen collection and result records attached
• Deficiencies or non-conformances documented
• Corrective actions assigned with owner and due date
• Inspector signature