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Staff Name

1.0 Key Rounding Questions

1.1 What is working well?

1.2 What staff should I recognize?

1.3 Do you have the tools and equipment you need to do your job?

Is there anything I can help you with right now?

2.0 Outer Building Appearance

2.1 Are the hours of operation posted?

2.2 Are hedges neatly trimmed around the building?

2.3 Are the flower beds neat and free of trash and debris?

2.4 Does the building need to be pressure washed?

2.5 Are the tobacco free signs posted for the public to see?

2.6 Are all signs appropriate and in good condition?

3.0 Patient Waiting Area

3.1 Are the Notice of Privacy Practice booklets available for patients?

3.2 Are the CHSI and SGHS pamphlets displayed in a brochure rack?

3.3 Is there a hand sanitizer with drip tray in waiting area?

3.4 Is the patient waiting area clean and free of clutter?

3.5 Is the television turned to an appropriate channel?

3.6 Is the Missed Appointment Policy displayed for patient review?

3.7 The Patient Bill of Rights with the HIPPA contact is posted in plain view for patients?

3.8 Are there drug company pamphlets and/or advertisements in the waiting area?

3.9 Does the practice have a clock in the patient waiting area?

3.10 The "No Cell Phone" or "Silence Your Cell Phone" sign is posted in patient waiting area?

3.11 The "Co-Payment is Due at the Time of Service" sign is posted at patient check-in?

3.12 Are magazine subscriptions out of date?

3.13 Is the furniture in good repair?

4.0 Reception Area

4.1 Are team members wearing identification badges?

4.2 Are signs and notices taped to the glass or walls?

4.3 Is the approved Return Check notice affixed to window?

4.4 Are team members aware of prompt pay discount? Employee discount?

4.5 Are patients greeted promptly and cheerfully?

4.6 Are team members familiar with the Financial Assistance program for self pay patients?

4.7 Are patients notified appropriately of provider delays?

4.8 Is there a patient sign-in sheet available?

5.0 Patient Exam Rooms

5.1 Are there locks on the exam room doors?

5.2 Are the walls / floors scuffed and dirty?

5.3 Are there signs taped to the walls in the exam rooms?

5.4 Are there clocks in the exam rooms?

5.5 Are the equipment and furniture in good repair?

5.6 Are the exam rooms stocked with supplies?

5.7 Do the exam rooms appear to be clean and clutter free?

5.8 Are there Sharps Containers in each exam room?

5.9 Are the Sharps Containers full?

7.0 Bathrooms

7.1 Are bathrooms cleaned and stocked?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.