Bournon

• Document No.

• Audit Title

• Prepared by

Location details

• Location and delegate

• Audited by:

• Date of audit

  Date

Medical Device Inventory

• Is there a Medical Device Inventory?

  Yes

  No

  N/A

• List all equipment audited:

Equipment

• Equipment name

• Serial number

• Add media

  Media

• Is this equipment on datix?

  Yes

  No

  N/A

• Is the equipment clean?

  Yes

  No

  N/A

Maintenance and Servicing

• Is there evidence that each piece of equipment is routinely maintained and tested in line with Manufacturers instructions?

  Yes

  No

  N/A

• Is there a documented maintenance schedule?

  Yes

  No

  N/A

• Is there a documented repair procedure?

  Yes

  No

  N/A

• Are the repairs recorded?

  Yes

  No

  N/A

• Do all staff know where to find repair records?

  Yes

  No

  N/A

• Do the staff know how to report a faulty/broken device?

  Yes

  No

  N/A

Training

• Are there training records to demonstrate which staff are competent to use the equipment?

  Yes

  No

  N/A

• Is this regularly submitted to OLM?

  Yes

  No

  N/A

Sharps documentation

• Are there documents/procedures to support incident reporting?

  Yes

  No

  N/A

• Are there procedures for using and disposing of instruments?

  Yes

  No

  N/A

Devices

• Are there any safety engineered devices?

  Yes

  No

  N/A

• Are the sharps bins in close proximity to the usage area?

  Yes

  No

  N/A

• Action Plan

Action

• Description

• By whom?

• By when?

  Date

Audit confirmation

• Witnessed by:

  Sign

• Audited by:

  Sign