Infection Prevention and Control Online Assessment

This is being offered to your facility at no charge and will be assessed by Phenelle Segal, RN, CIC, certified infection prevention and control consultant as a “first step” in assisting you with identifying gaps in practice.

The purpose of this initial assessment is to provide you with an outline of your infection prevention and control program and the basics needed to ensure you are on the right path for A) compliance with accreditation agencies (e.g., The Joint Commission, AAAHC), federal regulations (e.g., CMS, OSHA, CDC/NHSN), state regulations (title, senate bill and others), and B) appear to have basic strategies in place to for patient and employee safety.

In order for your program to be adequately assessed, it is important to have a staff member who is well versed in your infection prevention and control program fill this out as accurately and thoroughly as possible.

Upon completion of this form, it will be assessed and results provided to you via e-mail within five (5) business days.

All information submitted will be kept strictly confidential. Answer questions to the best of your ability.

General Information
Contact Person Name *
Contact Person Name
Is your facility surveyed by an agency or accreditation organization?
If YES, which agency or organization has conducted the survey?
Infection Prevention and Control Program