*1.Please enter your Employee ID Number.(Required.)

*2.Unit observed for hand hygiene:(Required.)

2N

4B

5A

5B

6A

6B

6E

6H

6I

6K

7A

7C

7U

7W

8E

8F

8G

9E

9F

9G

10E

10G

10H

11G

11E

12E

12F

Labor & Delivery (CC)

Nursery/Postpartum (CC)

3N (CC)

3W (CC)

4N (CC)

4W (CC)

5E (CC)

5W (CC)

6 (CC)

Other (please specify)

3.Case Manager

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

4.Dietary

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

5.Environmental Services (EVS)

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

6.Health Care Technician (HCT/MOA/UST)

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

7.Licensed Practical Nurse (LPN)

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

8.Medical Student

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

9.Nurse Practitioner

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

10.Nursing Student

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

11.Physical/Occupational/Recreational/Speech Therapist

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

12.Physician

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

13.Physician Assistant

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

14.Registered Nurse (RN)

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

15.Respiratory Therapist (RRT)

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

16.Social Worker

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

17.Spiritual Care

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

18.Transporter

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5

19.Volunteer

1

2

3

4

5

Hand Hygiene- YES

1

2

3

4

5

Hand Hygiene- NO
(Did Not Intervene)

1

2

3

4

5

Hand Hygiene- NO (Intervened)

1

2

3

4

5