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Genix Healthcare Compliance Form
Genix Healthcare Compliance Form
Anonymous

Genix Healthcare Compliance Form

Genix Compliance Form

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Free Genix Healthcare Compliance Form Checklist

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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

Genix Healthcare Compliance Form
Anonymous

Genix Healthcare Compliance Form

Genix Compliance Form

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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