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E. Sputum Collection Checklist
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1.
Name of Contractor Completing Survey:
(Required.)
Directly observe sputum collection by watching several applicants undergo this process
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2.
Identity is verified using photo ID, official documents, or signature.
(Required.)
True
False
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3.
Sputum is collected under supervision.
(Required.)
True
False
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4.
Access to the collection area is restricted.
(Required.)
True
False
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5.
Personal items are not allowed in the collection area.
(Required.)
True
False
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6.
Request forms are labeled with barcodes or unique identifiers.
(Required.)
True
False
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7.
Containers do not include applicant names.
(Required.)
True
False
Collection Area Conditions (attach photos of collection area separately, do not include pictures of applicants)
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8.
Collection area has adequate air exchange and privacy
(Required.)
True
False
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9.
Setting where sputum collection is conducted.
(Required.)
Indoor
Outdoor
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10.
If indoor, collection booths have negative pressure and UV light source.
(Required.)
True
False
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11.
Equipment and area are cleaned and disinfected between applicants.
(Required.)
True
False
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12.
Bottled/distilled water or saline (not tap or cooler) is used for rinsing mouth during sputum collection.
(Required.)
True
False
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13.
Hand hygiene materials (sink or sanitizer) are available.
(Required.)
True
False
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14.
Instructional materials (signs, videos, etc.) are visible.
(Required.)
True
False
Collection Method
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15.
Instructions (fasting, no antibiotics) are provided in advance.
(Required.)
True
False
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16.
Collection is conducted with clear counseling or instruction.
(Required.)
True
False
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17.
A high-quality standard operating procedure is in place and up to date.
(Required.)
True
False
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18.
Three early morning fasting specimens are collected on separate days.
(Required.)
True
False
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19.
Specimens are collected under direct observation.
(Required.)
True
False
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20.
Proper containers (10–50 ml, wide-mouth, screwcap) are used.
(Required.)
True
False
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21.
Technicians are trained in collection and induction methods.
(Required.)
True
False
Specimen Quality
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22.
Specimens are checked visually before applicant leaves.
(Required.)
True
False
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23.
Each specimen is at least 5 ml and not saliva.
(Required.)
True
False
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24.
Specimens are placed in biohazard bags and refrigerated promptly.
(Required.)
True
False
Safety Measures
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25.
Technician wears gown, gloves, and N95 mask.
(Required.)
True
False
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26.
Maximum of four applicants per technician at a time.
(Required.)
True
False
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27.
Tissues are provided for applicant use.
(Required.)
True
False
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28.
Biohazard waste protocols are followed for disposal.
(Required.)
True
False
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29.
Specimens are transported in a secure outer container.
(Required.)
True
False