Hand Hygiene Observation Form
Data Collector
First Name
Last Name
Site Location
*
Please Select
Skillman North
Skillman South
Skillman East
Hannan Ranch
Lohrman
Rebecca
Magnolia
Sonoma Mountain
Penngrove North
Penngrove South
Auberry North
Auberry South
Bradley
DaVinci
Mary
Washington IOP
Fresno IOP
Month
Hand Washing Observations
Rows
Date
Shift
Staff Type
HW before client contact
HW after client contact
HW before/after handling food
HW after using restroom
Obs 1
Obs 2
Obs 3
Obs 4
Obs 5
Obs 6
Obs 7
Obs 8
Obs 9
Obs 10
Comments
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