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Exhibit 351 ASC INFECTION CONTROL SURVEYOR WORKSHEET Name of State Agency or AO (please specify) Instructions: The following is a list of items that must be assessed during the onsite survey, in order
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How to fill out an infection surveyor worksheet:

01
Start by carefully reading the instructions provided with the infection surveyor worksheet. Make sure you understand the purpose and requirements of the worksheet before proceeding.
02
Gather all relevant information that may be needed to complete the worksheet accurately. This may include details about any infection cases, sources, or affected individuals.
03
Begin filling out the worksheet by entering the necessary information in the designated fields or sections. This could include recording dates, names, locations, and any specific details related to the infection.
04
Use clear and concise language when providing information on the worksheet. Be specific and provide as much detail as possible to ensure accuracy and ease of use for others who may refer to the worksheet later.
05
If there are any optional fields or sections that are not applicable to your situation, leave them blank or indicate "N/A" (not applicable) to avoid any confusion.
06
Double-check your entries for any errors or missing information. It is crucial to review your work to ensure the accuracy and completeness of the worksheet.
07
Once completed, make sure to save or submit the infection surveyor worksheet according to the required instructions or guidelines provided by the relevant authorities or organization.

Who needs an infection surveyor worksheet?

01
Healthcare professionals: Doctors, nurses, healthcare workers, or infection control professionals who are responsible for monitoring and reporting on infections within a healthcare setting may need an infection surveyor worksheet.
02
Public health organizations: Government agencies, public health departments, or research institutions involved in tracking and controlling the spread of infections may utilize an infection surveyor worksheet to gather necessary data.
03
Workplace safety officers: Companies or organizations with a focus on employee health and safety may require an infection surveyor worksheet to assess and address any potential infection risks in the workplace.
04
Educational institutions: Schools, colleges, or universities may use an infection surveyor worksheet to track and manage outbreaks or infections among students, staff, or faculty members.
Note: The requirement for an infection surveyor worksheet may vary depending on the specific context, regulations, or guidelines set by the relevant authorities or organizations in different regions or industries. It is important to refer to the specific guidelines or consult with the appropriate authorities to determine who needs to use or fill out an infection surveyor worksheet in a given situation.
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The Infection Surveyor Worksheet is a document used to assess and document infection control practices in a healthcare setting.
Healthcare facilities and providers are required to file the infection surveyor worksheet.
The infection surveyor worksheet is filled out by reviewing and documenting infection control practices and procedures in the healthcare setting.
The purpose of the infection surveyor worksheet is to evaluate and improve infection control measures in healthcare facilities to prevent the spread of infections.
Information such as infection control policies, procedures, training records, and infection surveillance data must be reported on the infection surveyor worksheet.
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