Form 1 D. Audit

User Daily Operational Checklist

• Clinic Location

• Room No.

  Room 1

  Room 3

  Growth Room

• Type of Laser Equipment

  Candela Gentle Lase Mini

  Candela Gentle Yag Mini

  Candela Gentle Lase Pro

  Candela Gentle Yag Pro

• Date of Audit

  Date

First Aid and Fire Protection

• Fire extinguisher easily accessible?

  Yes

  No

• First aid equipment easily accessible?

  Yes

  No

Non beam Hazards

• No Flammable and oxidizing materials in room?

  Yes

  No

Signage

• Warning and laser class signage erected on access door?

  Yes

  No

• Illuminated warning signage on access door in working order?

  Yes

  No

Housekeeping

• Laser room free of any trip hazards?

  Yes

  No

Personal Protective Equipment

• Protective eyewear available for user and client?

  Yes

  No

• Protective eyewear clearly labelled of appropiate OD and wavelength?

  Yes

  No

• Protective eyewear free of damage, debri and dirt?

  Yes

  No

• Disposable gloves readily available?

  Yes

  No

• Face masks / shields readily available?

  Yes

  No

• Sharps container readily available?

  Yes

  No

Laser Controlled Area

• No reflective surface and materials?

  Yes

  No

• Windows covered with non-reflective material?

  Yes

  No

• No combustible / flammable materials?

  Yes

  No

• Good ventilation system through general dilution or local exhaust?

  Yes

  No

Equipment Integrity

• Surface exterior, handpiece and distance guage clean of dust and debris?

  Yes

  No

• Laser windows inspected and free of dirt, debris and burnt areas?

  Yes

  No

• No sign of liquid on ground or leakage from equipment components?

  Yes

  No

• No damage to exterior housing?

  Yes

  No

• No damage or entaglement of electrical cords, circuit breakers, footswitch cables and sockets?

  Yes

  No

• No damage or entanglement to entire length of optical fibres, clean and chip free at both ends?

  Yes

  No

• Water levels checked and topped up where required (distilled water only)?

  Yes

  No

• Full range movement and no damage entaglement of articulated arm and lens?

  Yes

  No

• No damage to handpiece?

  Yes

  No

• Successful calibration of beam power / pulse energy / delivery power / aim beam quality?

  Yes

  No

Room Preparation

• Adequate supplies readily available?

  Yes

  No

• Lighting adequate when laser in / out of use?

  Yes

  No

• Pre / post care readily available?

  Yes

  No

Additional Notes

• Notes:

Non-conformance Details

• Details:

Acknowledgement

• Name of Auditor:

• Signature:

  Drawing