This form is a template provided by CDC to assist facilities with monitoring adherence. This form can be used “as is” or modified to accommodate a facility's unique needs.
PDF Format PDF (23KB / 1 page)
MS Powerpoint Format (60KB / 1 page)
This page last reviewed December 17, 2004
This page developed and maintained by: Division of Healthcare Quality Promotion National Center for Infectious Diseases Centers for Disease Control and Prevention
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