Tools and Forms


The Nebraska ICAP team frequently provides assistance to infection preventionists in setting up various infection control measures. During this process, sometimes we develop new tools for them or suggest use of certain tools/forms that are already available. We have compiled the more commonly used tools and forms and divided those into categories. Please click on the categories below to find all the available tools/forms within that category.

CDC Infection Control Self-Assessment Tools

CLABSI Prevention

CMS Audit Tools

Device Disinfection/Sterilization

Environmental Cleaning and Disinfection

Environmental Rounding

Hand Hygiene

Indwelling Urinary Catheters

Infection Control Committee resource

Infection Prevention Risk Assessment for High Risk Tasks

Infection Surveillance

Injection Safety

Long Term Care Illness Logs and Tracking

Medication Administration

Observation Tools to Download


Personal Protective Equipment

Product Evaluation Process

Refrigerator Temperature Log

Risk Assessment for Long-Term Care Facilities

Staff audit documentation tool


Transfer Form

UTI Diagnosis, Treatement and Prevention

Visitor Screening

If you are unable to find a resource on our website, please feel free to contact us by emailing We will try to help you in finding that resource and if possible make it available on our website for others.

Page last reviewed: June 29, 2021