Appendix K

Infection Prevention and Control Induction Checklist For Volunteers
(including those on Work Experience)
Name of volunteer:
Ward/dept:
Contact number:
Name of Manager/Supervisor :
Contact Details:
Topic / Aim / Requirements / Date Achieved
Hand Hygiene / Understand the importance of hand hygiene /
  • Staff member is observed to follow the correct hand hygiene procedure using (soap and water or alcohol hand rub)
  • Has read the hand hygiene policy
  • Can list 5 situations when hands need to be cleaned during their volunteer duty
  • Can list the 2 situations when alcohol hand rub use is ineffective
  • Presents for duty ‘bare below the elbows’ if undertaking any volunteer duty which involves patient contact or contact with the clinical environment.
  • Can identify the location of hand hygiene facilities (soap and water and alcohol hand rub) in their area.

Routine practices to prevent the transmission of infection / Is able to recognise the isolation posters used in community hospitals and has a basic understanding of when they are used. /
  • Is able to recognise the Source Isolation poster (red) and Protective Isolation poster (blue).
  • Knows to contact the ward to discuss whether to present for duty in the event of a ward closure due to infection.
  • Knows to speak to nurse in charge if further advice is needed.
/ :
Personal protective equipment (PPE) / Is able to recognise when PPE (gloves and aprons) are required – if this is applicable. /
  • Can verbalise when single use gloves are indicated i.e. when in contact with:
Body fluid
A chemical
A service user who is undergoing specific precautions to prevent the spread of infection
  • Can demonstrate when to put on PPE
and when to remove it when visiting an isolation room (if applicable)
  • Can demonstrate how to remove PPE, so as to minimise self-contamination
  • Can verbalise when protective clothing should be removed and hands washed during the course of their volunteer duty
  • Knows to speak to nurse in charge if further advice is needed.

Decontamination and cleaning / Understands that any re-usable equipment used in a clinical environment or in direct contact with patients must be kept clean. /
  • The volunteer can state how frequently they should decontaminate any equipment that they use
  • Understands what product can be used to decontaminate the equipment and where to locate the product.
  • Knows to speak to nurse in charge if further advice is needed.

Waste /
  • The volunteer can identify which colour bag they should use for any waste that they generate during their duty

Personal safety / Know the correct actions to take to maintain their own safety in the clinical environment. /
  • Knows to inform the nurse in charge of any of the following:
  1. If they see a used sharp object such as a needle and syringe.
  2. If they see a spillage of blood or body fluids.
  3. The volunteer must not attempt to clear any spillage themselves or dispose of used sharp instruments.
  • Knows the basic first aid (e.g. allow to bleed, wash and report to Manager) in the event of a needle stick injury, bite, or blood splash to face

Fitness to work /
  • Understands the importance of remaining at home if they are unwell e.g. have diarrhoea and vomiting.

Signature of Manager/Supervisor: / Date
Signature of volunteer: / Date
This local induction checklist links with the Southern Health Induction Policy and Work Experience and Volunteer Policy and Procedure SH HR 33A signed copy should be retained locally.

1

Organisational Induction Policy

Version 3

April 2017