• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Clinical Governance

  • We're there any issues with random questioning for nurses on CQC Outcomes?

  • We're there any issues with random questioning of Nurses about tests being carried out? Provide details what tests were checked

  • Are Daily, Weekly and Monthly checklists being completed

  • Is the Compliance Calendar in place and up to date?

Clinical Governance Document Checklist

  • Is the Health and Safety Poster displayed?

  • Is the employers liability insurance certificate displayed?

  • Are Local Rules for Radiographic Equipment Displayed

  • Is the CQC Registration Certificate displayed?

  • Is the practice policy on health and safety and accident book available?

  • is the Risk assessment and COSHH Available?

  • is the Emergency drugs kit, Oxygen check dates and service records available?

  • Are certificates of autoclaving servicing/maintenance up to date and available

  • Are certificates of pressure vessel inspection for all compressors operating above 250bar available and up to date?

  • Are service records for compressors up to date and available?

  • Is the Performing Rights certificate up to date and available?

  • Are the safety checks and pat testing on all electrical equipment and all certificate of testing fixed supplies up to date and available.

  • Are clinical waste and special waste including sharps consignment notes up to date and available?

  • Are domestic waste consignment notes up to date?

  • Are records of cleaning up to date and available? Is there a cleaning schedule?

  • Are records relating to radiation safety assessment of all radio graphic equipment up to date and available?

  • Are signs for fire exits, fire risk assessments and procedures in case of fire present and displayed correctly?

Staff records

  • All GDC Registrations and professional indemnities in place?

  • All immunisation records for all staff in place?

  • All staff inductions in place?

  • All staff contracts in place?

  • All CRB checks in place?

  • All CPR for staff up to date?

  • All child protection/vulnerable adults certificates up to date and available?


  • Please enter the Number of UDAs performed and targeted for this month so far. <br>I.e. 'Surgeon' 123 UDAs performed 321 UDAs targeted <br>

  • Please state the reason for a difference in UDAs performed/targeted if applicable

  • Please enter the Private performed per surgeon



  • Is the ordering currently within budget? If not state the amount of overspend

  • Does the practice require any particular materials?

  • Does the practice use dentsply rewards

  • Are all points within their availability date? If not, how soon are they going to expire?


  • Is a petty cash book in place and being used?

  • Have bank statements been checked?

  • Have private/NHS receipts been checked?


  • Has Maggie been informed of refunds required? Have refund request forms been sent?


  • Cleanliness/decor of waiting rooms, surgeries and other rooms ok?

  • Are all suction motors in working order?

  • Are the Suction Motor Filters been cleaned regularly?

  • Have any engineer visits been required?

  • If yes to the above, have you kept the old part to show to Dr Kanani?

  • All Large Equipment e.g. Chairs ok and in working order?


  • Handpieces ok?

  • Curing lights ok?

  • Instruments ok?

  • Intra oral cameras ok?

  • All other small equipment ok? Please give details of any issues


  • Have the gas/electricity meter readings for this week been sent to Nadeem?

Friends and Family Test (FFT) Questionnaires

  • Are FFT Questionnaires being completed for every patient seen?

  • Have the last months FFT Questionnaires Results been sent to This must be done by the 10th of the month.


  • Is the monthly new patient referrals chart being completed and sent to Mehria/Nadeem?

  • Are Patient Satisfaction Questionnaires being completed and uploaded online (at least 10/week)

  • Is there a record of new patients registered last month? If so, how many?

  • Are there any outstanding recalls to be sent? If so, how many?


  • Is all software and hardware in working order?

  • Is one server PC being left on to allow for remote access?

  • Is the Google Calendar being updated with all important dates/deadlines?


  • Are the accounts/incorrect claims up to date and have they been sent to Andrea?

  • Which months are outstanding still to do?


  • Has the monthly cash book for last month been sent to Maggie/Nadeem?

  • Have last months lab bills been sent to Maggie/Nadeem?


  • Does this practice stock sundries?

  • Do the sundries in stock match the sundries log?

  • Is everything in order with the sundries cash book entries?

Text Messaging

  • Does the practice follow up on daily text messaging reports? Please indicate how many patients details have been altered and how many have been removed from the messaging list.

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.