Policy Manual sample

MDT Home Health Care Agency, Inc. BAG TECHNIQUE COMPETENCY EVALUATION Employee Name: __________________________________________ Title: _________ Items Yes No N/A Comments 1. Bag is placed on clean hard surface 2. Barrier is utilized as appropriate 3. Bag is placed out of reach of children and animals 4. Antiseptic no rinse gel or towelettes is available for Handwashing if necessary 5. Washes hands before entering the bag 6. Equipment used is cleaned prior to returning to bag if appropriate 7. Clean and dirty supplies are maintained separately 8. Supplies are maintained in the bag and checked for expiration on a regular basis Additional Comments: * Never Place the Bag on the Floor or Upholstered Furniture * Never Take a Bag into a house with bed bug or insect infestation. * Never take a Bag into a house with MRSA or antibiotic resistant organism. Signature/Title of Evaluator:________________________________ Date:__________ Home Health Agency Nursing Care & Procedures K-137