Custom Clinical Evaluation Form - Reducing Surgical Complications: SSI & VAP

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Clinical Evaluation Form

To create your custom Clinical Evaluation Form, start by entering the following information:

Your Name:		Click here to print the full list of questions. Click here to print a sample of a finished form.
Facility Name:
Unit:
Return Form To:

Next, check the boxes next to the questions you would like to have printed on the form. A maximum of 6 questions can be selected. When finished, click "Next Step."

The product instructions are clear and easy to follow.

I like the convenience of the skin antiseptic in a premoistened cloth.

The package provided an appropriate number of cloths for adequate skin preparation.

This product is easy to use on body contours and difficult-to-prep areas such as skin folds.

This product saved time over previous methods of patient preoperative skin preparation.

There are no drips, runs or pooling when using these cloths.

I believe this product will help improve patient and nursing compliance for preoperative skin preparation.

This product makes it easier to follow my unit's protocol for patient preoperative skin preparation.

The cloths were smooth and comfortable on my patient's skin.

This product is preferred over previous methods of patient preoperative skin preparation.

I believe this product is an improvement in the quality of patient care at this facility.

I recommend this product over previous methods of patient preoperative skin preparation.

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