Clinic Audit

• Site conducted

  Select

• Conducted on

  Date

• Audittee

• Location
  Address

Clinic Equipment

• Clinic is orderly and free of clutter

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a valid clinic license in place?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Thermometer, stethoscope and sphygmomanometer are in working order

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Are weighing scales and height measure equipment available

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is all basic resuscitation equipment available and in good working order in the clinic such as defibrators, oxygen cylinder, face mask with connectors and laryngoscope

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there access to a tourniquet and needles (both sterile and disposable)

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is the dressing trolley well stocked with equipment such as sterile water, gloves, gauze and cotton? Is there a kidney shaped bowl?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is the dressing trolley moveable and in good working order

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a blood glucose instrument (prick method) is this in good working order

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there have access to an examination lamp. Is it in working order

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a diagnostic set for ENT and eyes. Is it in good working order with all parts

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there access to an Intravenous Stand, canula’s and butterfly needles? Is there an infusion set eg. Bag of fluid and line?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Are there Splints available and in various sizes?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a nebulizer and mask? Is the nebulizer in good working order will all parts?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there disposable tongue depressors

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there disinfection solution (Betadine solution, Alcohol 70% or Iodine). Is there medical soaps or hand disinfectant solutions?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there access to a foldable stretcher?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Are there potable screens and curtains? Are they in good working order and well maintained?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a lockable cabinet for medical records

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there access to a wheelchair. Is this in good working order with all parts?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Are there special containers for medical waste

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a sharps box

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there an observation bed (adjustable height). Is this in good working order?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there a lockable refrigerator to keep vaccines and drugs? Is this well maintained and fit for purpose. Is there a lockable medication cabinet?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

• Is there disposable paper hand towel or electric hand dryer?

  Compliant

  Moderately Compliant

  Non-Compliant

  N/A

Performance