PERFORMING TREAMENT ROOM CLEANING & DISINFECTION TASK EVALUATION SHEET

PERFORMING TREATMENT ROOM CLEANING & DISINFECTION TASK EVALUATION SHEET

Please add the student name as shown on the ID

Objective: The students will demonstrate the proper technique for performing treatment room cleaning and disinfection.

Competency: The student will set up armamentarium and Students will be taught the proper routine procedure that meets stated protocols for the proper technique for performing treatment room cleaning and disinfection. The student will pass with a minimum score.

Practice Required: 3

 Assembled the appropriate setup. Wore the appropriate personal protective equipment.

Checked to see that the preclearing/disinfecting product had been correctly and was fresh. Read and followed the manufacturer’s instructions.

Sprayed the paper towel or gauze pad with the product and vigorously wiped the surface.

Sprayed a fresh paper towel or gauze pad with the product.

Allowed the surface to remain moist for the manufacturer’s recommended time.

Total Possible Points = 20 points

Minimum passing score = 20 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

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