1. Safe Sleep Audit Tool

* 1. What month are you doing this audit?

* 2. What unit is the baby on?

* 3. How old is the baby (use their birthdate not gestational age)?

* 4. Is the baby sleeping in:

* 5. Is there a medical exception for sleeping on the back based on diagnosis or treatment?

* 6. What is the baby's sleep position?

* 7. Is the head of the bed flat?

* 8. Are there any objects in the infant's sleep area during sleep?(Select all that apply)

* 9. Are there any extra linens that are loose in the sleep area? (Select all that apply)

* 10. What is the baby wearing or is bundling used? (select all that apply.)

* 11. Is a developmental device (frog,bendy bumper,etc) being used properly? They are not to be placed on top of babies or to hold a pacifier in the mouth. Skip this question if there is not one in use.

* 12. Is this baby in a safe sleep environment?

* 13. Was feedback given to staff?

* 14. What other questions do you have?

* 15. This was entered into Survey Monkey.