Please enter your Employee ID Number.

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* 1. Please enter your Employee ID Number.

Unit observed for hand hygiene:

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* 2. Unit observed for hand hygiene:

Case Manager

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* 3. Case Manager

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Dietition

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* 4. Dietition

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Environmental Services (EVS)

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* 5. Environmental Services (EVS)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Health Care Technician (HCT/UST/MOA)

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

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Licensed Practical Nurse (LPN)

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* 7. Licensed Practical Nurse (LPN)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Medical Student

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* 8. Medical Student

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Nurse Practitioner

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* 9. Nurse Practitioner

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Nursing Student

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* 10. Nursing Student

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Occupational Therapist (OT)

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* 11. Occupational Therapist (OT)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Physical Therapist (PT)

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* 12. Physical Therapist (PT)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Physician

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* 13. Physician

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Physician's Assistant (PA)

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* 14. Physician's Assistant (PA)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
PICC Team

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* 15. PICC Team

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Radiology Tech (RT)

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* 16. Radiology Tech (RT)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Recreational / Speech Therapist

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* 17. Recreational / Speech Therapist

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Registered Nurse (RN)

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* 18. Registered Nurse (RN)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Respiratory Therapist (RRT)

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* 19. Respiratory Therapist (RRT)

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Social Worker

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* 20. Social Worker

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Spiritual Care

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* 21. Spiritual Care

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Tray Passer

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* 22. Tray Passer

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Transporter

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* 23. Transporter

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)
Volunteer

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* 24. Volunteer

  1 2 3 4 5
Hand Hygiene- YES
Hand Hygiene- NO
(Did Not Intervene)
Hand Hygiene- NO (Intervened)

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