Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Decon
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Start of Session:
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Put on PPE
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Wipe all surfaces using alcohol-free wipes
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Ensure all switches are turned on
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Thermometer ready for manual scrubbing
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Prepare the following; (tick if applicable):
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Manual scrubbing sink, Cold water disinfection bath, Water distiller, Aprons Solutions
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Check stock; ( Take picture if re stock needed)
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Hand wash dispensers, PPE, Pouches, Disinfectant wipes , Lint free cloths , Solutions
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Check stock; ( Take picture if re stock needed)
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Handpiece oil, Protein tests, Validation equipment (TST strips)
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Ensure magnifying inspection lamps are working correctly
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Ensure transport boxes are cleaned and correct dirty boxes are available in surgeries
Every day the following tasks must be completed:
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Checklist for Manual Cleaning
End of session:
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Ensure all instruments are processed
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Ensure manual cleaning sink is emptied and cleaned
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Drain Autoclave water chamber
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Clean and disinfect all work surfaces and sinks
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Ensure all validation has been completed and checklist complete
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Ensure room is left clean and clutter free
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Report any maintenance issues to Practice Manager
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Change Reservoir Water
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Dispose of all clinical waste
Autoclave:
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Serial Number
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Steriliser Type: Type N (Non-Vacuum) Type N (Non-Vacuum) Type S (Vacuum)
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Daily Test Record
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Automatic Control Test
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Cycle Number
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During the sterilisation part of the cycle, what was the:
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Maximum Temp
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Minimum Temp
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Pressure Reading
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Sterilisation time
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Outcome
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didi you notify the manager/lead nurse
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Steam Penetration Test
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Date
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Cycle Number
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TST
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Name
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Weekly Maintenance tasks;
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Wipe door seal with non-linting cloth
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Wipe chamber with non- linting cloth
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Clean all external services
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Person carrying out tasks
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Cycle Number:
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Evidance:
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Signature: