Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
Practice Name
- Alnwick
- Beeston
- Blackpool
- Cirencester
- Conisbrough
- Eastleigh
- Edinburgh
- East Park
- Garforth
- Gloucester
- Havant
- Huddersfield
- Hull
- Kiverton
- Leicester
- Market Weighton
- Marske
- Mexborough
- Middlesbrough 222
- Middlesbrough 226
- Morley
- Skelton
- Tickhill
- Whitley Bay
-
Auditor / Compliance Manager
- Yes
- No
- N/A
-
Cluster Manager
-
PM Name
-
PM Assistant Name
-
Date of first visit
-
Date of update visit/next visit
Practice Appearance & Patient Journey
-
Disability access appropriate / free from blockages / pathway clear and even
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
NHS Charges posters clearly displayed and up to date
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Private fee scale clearly displayed
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Complaints procedure clearly displayed and up to date
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
NHS paperwork in use (FP17PR, FP17DC) and MH forms being updated rather than new for each patient
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Patient records available (duplicates not in use)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Staff
-
Uniform clean and presentable
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Name badges worn/identification of team role
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Emergency drugs checked daily along with AED before patients are seen (time/date and signatures -2 checks inc. one clinician)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Check contents against list-all present /in date
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Oxygen cylinders full (gauge in green) checked daily before patients are seen
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Therapeutic/BVM masks available in adult/child sizes
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
DE Fib light green (Rescue Ready) or equivalent
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Pocket masks in each surgery and visible
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Training record of CPR with attendance list
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Health & Safety - Radiation check
-
Signage
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Use of rectangular collimators
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Procedural checks - patient
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Panels seen during exposure
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Local rules and Risk Assessment
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Health & Safety - Sharps Avoidance
-
Risk Assessment completed
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Use of re-sheathing device in absence of "safer sharp"
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Dentists managing sharps
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Occupational Health Advice notice clearly displayed
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Staff awareness of process
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Inoculation records seen
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Fire Safety
-
Fire exits clear
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Fire doors unlocked
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Practice Audits
-
IPS tool completed within last 6/12 (PM)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Radiation audits seen at least 12/12 (Dentists)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Record keeping audit in last 6/12 (PM)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
DBOH audit by dentist within 12/12 and evidence of adoption of DBOH3 in practice
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Referral audit by PM within 6/12 (PM)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Prescription audit by PM within 6/12 (PM)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Recalls interval audit within 6/12 (Dentist)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Waiting times audit 6/12 (PM)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Missing Signage/ Certificates/ Leaflets
Cross Infection & Decontamination
-
Decon log books completed appropriately
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Observation of procedure
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Staff awareness of process
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Clinical waste appropriately stored
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Sharps disposal appropriate (container/contents/position)
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Special waste, appropriate use of containers and storage
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Clinical Records checked against FGDP (UK) Gold Standard
-
Radiographs in line with FGDP (UK) guidelines
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Treatment planning and delivery meeting including choices
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Private treatment
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Claiming pattern
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Complaints
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
-
Communication
-
Comments & Actions
-
Add media
-
Responsible
-
Date to be completed
-
Completed
Summary
-
I fully understand the audit as completed the auditor.
-
Practice Manager / Asst Practice Manager
-
Auditor
