Annual Laser Safety Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

• Review of Adverse Incidents

• Review of Maintenance Records

• Review of Staff Training

• Has the Annual Planned Training Been Completed?

  Yes

  No

  N/A

• Is All Staff Training Within Date?

  Yes

  No

  N/A

• Review and Update Local Rules

• Review of Contingency Plan

• Review of Patient Satisfaction Rates

• Review Usage of Each Laser

• Has There Been an Annual Safety Update for All Staff?

  Yes

  No

  N/A

• Is There a Plan for Continued Training?

  Yes

  No

  N/A

• Review of Staff Participation Forms Relating to Laser

• Hold Laser Review Meeting with Authorised Users

• Review of Laser Fault Log Book

• Review Smoke Evacuation System and Filter Maintenance

• Review Fire Safety Equipment (Extinguishers)

Comments and actions needed

• Comments and actions needed