Run COVID-19 Point Prevalence Survey Log — Free

Inspection Details

Facility name critical (required)

Survey date and time critical (required)

Outbreak or suspected outbreak identified critical (required)

Yes No N/A

Testing round identifier critical (required)

Enter the point prevalence survey round number or event identifier.

Population Tested

Residents eligible for testing critical (required)

Residents tested critical (required)

Staff eligible for testing critical (required)

Staff tested critical (required)

All available residents included in the survey critical (required)

Yes No N/A

Test Administration and Results

Test type used critical (required)

Tests administered critical (required)

Positive results critical (required)

Negative results critical (required)

Indeterminate or invalid results

Results reported to infection prevention leadership critical (required)

Yes No N/A

Infection Control Follow-Up

Positive cases isolated or cohorted per facility protocol critical (required)

Yes No N/A

Exposure notifications completed critical (required)

Yes No N/A

Contact tracing initiated for positive or exposed individuals

Yes No N/A

Additional testing or repeat testing scheduled

Yes No N/A

Documentation and Sign-Off

Specimen collection and result records attached critical (required)

Yes No N/A

Deficiencies or non-conformances documented

Yes No N/A

Corrective actions assigned with owner and due date

Yes No N/A

Inspector signature critical (required)

Get your results

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Email (required)

Your name (optional)

Run: COVID-19 Point Prevalence Survey Log

Inspection Details

Population Tested

Test Administration and Results

Infection Control Follow-Up

Documentation and Sign-Off

Get your results