Useful Forms and Tools

Links to Forms & Tools

The Center for Excellence in Assisted Living (CEAL) Quality Tools

HCANJ Quality Tools

RESPIRATOR Versus MASKS POSTER- FEEL FREE TO DOWNLOAD AND PRINT
Article reduce medication burden during Covid -19
Direct Care Staff Competency Checklist

Infection Control

IPC Risk Assessment spreadsheet (Excel) excel icon[XLS – 26 KB]
LTC Acute Gastroenteritis Outbreak Resources (print only) pdf icon[PDF – 7 pages]
LTC Acute Gastroenteritis Outbreak Line List (fillable Excel) [XLS – 39KB]
LTC Respiratory Outbreak Resources (print only) pdf icon[PDF – 7 pages]
LTC Respiratory Outbreak Line List (fillable Excel) [XLS – 32KB pages]
Inter-Facility Infection Control Transfer Form pdf icon[PDF -3 pages]

 

The National Adult and influenza Immunization Summit (NAIIS) has created useful tools for managing immunizations in the AL and skilled settings. Please feel free to utilize these tools for Best Practice and resident safety.

  1. Temporary Vaccine Clinic Best Pratctice Checklist
    This fillable (i.e. editable PDF*) checklist is a step-by-step guide to help clinic coordinators/supervisors overseeing vaccination clinics held at satellite, temporary, or off-site locations follow Centers for Disease Control and Prevention (CDC) guidelines and best practices for vaccine shipment, transport, storage, handling, preparation, administration, and documentation. This checklist outlines CDC guidelines and best practices that are essential for patient safety and vaccine effectiveness.
  2. Pledge for Organizations Implementing Vaccination Clinics Held at Satellite, Temporary, or Off-site Locations

    https://www.izsummitpartners.org/pledge-for-organizations-providing-vaccination-clinics

    This pledge is for organizations that conduct satellite, temporary, or off-site vaccination clinics to sign annually affirming that they will adhere to best practices, including using the Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations. Organizations that sign the pledge will be recognized on the Summit website for their commitment to provide safe and effective vaccine clinics. Companies seeking to hire an organization to conduct a vaccination clinic can check to see if that organization has signed the pledge and is recognized on the Summit website.

    Has your organization taken the pledge? Let us know (see instructions below) so that we can highlight your organization on our recognition page.

    Instructions for being recognized: Once your organization’s executive has signed the pledge, please send us an email with the subject “Vaccine Clinic Pledge Form”. In the message area, include your organization’s name and an email address for an organization contact. Please be sure to attach a copy of your signed pledge.

     

  3. https://www.izsummitpartners.org/content/uploads/2019/02/faqs-for-checklist-and-pledge.pdf

    This list of Frequently Asked Questions provides answers to some of the most common questions about the purpose of the checklist and pledge, the intended users of the checklist, and how to use the checklist, as well as technical questions.

  4. This document is a 1-page summary of the Checklist of Best Practices for Vaccination clinics Held at Satellite, Temporary, or Off-site Locations. This resource is not intended to replace the checklist. Rather, it is a quick reference guide highlighting the main points of the checklist that can be used by all staff (not just the clinic coordinators/supervisors who are completing the checklist). This document can be posted on the wall of the clinic or given out to all the staff who are vaccinating at the clinic.