DHSV Security of S3 & S4 Medications & Prescription Pads

• Document No.

• DHSV Security of S3 & S4 Medications & Prescription Pads

• Client / Site

• Conducted on

  Date

• Prepared by Marrianne Beaty

• Location
  Address

• Person conducting the Audit

DENTAL CLINIC

SURGERY 1

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 2

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 3

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 4

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 5

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 6

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 7

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 8

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 9

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No

SURGERY 10

S3 Medications

• Are all S3 medications stored in a secure area that is out of the reach of the public at all times in each surgery?

  Yes

  No

• Is this area locked in each surgery when staff are not in attendance?

  Yes

  No

S4 Medications

• Are all S4 medications stored in a locked area at all times in each surgery?

  Yes

  No

• Are the keys to the locked area carried by either the Dental Practice Manager or a Dentist at all times?

  Yes

  No

Prescription Pads

• Are Dentist's prescription pads stored in a locked area at all times in each surgery?

  Yes

  No