Generic Skin Care Questionnaire And Assessment Page 4
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4Reviewed by:
ACTION PLAN
Name:
Date:
Do not substitute hand hygiene products from the approved hospital supplied products
without prior permission.
ACTION
Commencement
Review date
Review date
Review date
Date:
Continue work and monitor
Continue work and avoid
soap/water unless indicated
Continue work persist using
approved ABHR
-if too painful return for
immediate review
Cover skin splits with
occlusive dressing/replace as
required
-if skin detoriates return for
immediate review
Medical Review required
Regular use of supplied
moisturiser
Home: use only
dermatological products for
hands/showering/shampoos
Home: use approved
moisturiser
Remove from current position
until further review
Other(please describe)
Please provide staff member with photocopy of this document.
Signature: staff member:
Signature: ICP/OHS
Outcome:
Document reviewed Nov 2012
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