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Antiseptic Body Cleanser 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 10 questions can be selected. When finished, click "Next Step."

I recognize the importance of routine skin antisepsis, and this new cloth based delivery method better facilitates this process.

This new Antiseptic Body Cleanser cloth based delivery method enables me to better meet my unit's skin care protocol.

The product instructions are 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 antisepsis.

This product is easy to use on body contours.

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

My patient responded favorably to the warm and comfortable Antiseptic Body Cleanser washcloths.

I believe this new prepackaged Antiseptic Body Cleanser method is an important improvement in the quality of patient care at this facility.

I recommend the Antiseptic Body Cleanser over our current method of delivering skin antisepsis.

I believe the Antiseptic Body Cleanser bath provides a better infection control measure.

The Antiseptic Body Cleanser's one-step cleansing and moisturizing washcloths enable me to use my time more efficiently.

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