Title Page

  • Site conducted

  • Prepared by

  • Date Conducted

  • Client & Site Name

  • Location

Previous Audits

Have previous audits been conducted at the facility?

  • Have previous audits been conducted at the facility?

  • Are there any outstanding actions? If so please carry forward to this audit and mark as urgent.

Staffing & Services

  • What positions are held at the facility?

  • How many casual staff are inducted at this facility?

  • Is the amount of casual coverage sufficient for this facility?

On Call Medical Staff

  • Does the facility use the CPAG 24/7 on-call doctor service?

  • Do after hours staff have access to the on call doctor in case of an emergency?

Appearance of Medical Facility

  • Does the facility meet best practice hygiene and cleanliness standards?

  • Are the bench tops clear of dust and dirt?

  • Is there good lighting for clinical examination?

  • Is there adequate temperature control and ventilation?

  • Are air conditioning systems regularly maintained?

  • Is there adequate work space for staff?

  • Is there adequate environmental protection such as insect control, dust screens etc?

  • Are there adequate consumables and equipment for WHO compliant hand washing - Clean running water, hand soap dispenser, paper towel dispenser, hand sanitiser?

  • Are floor surfaces clean and uncluttered?

  • Are all entries and walkways clear?

  • Is emergency lighting in place and operable?

  • Is there a cleaning service, are they effective and regular?

  • Is linen clean and are there adequate supplies at hand?

  • Are rubbish bins located at suitable points throughout the clinic?

  • Are they emptied regularly?

  • Are Biohazard bins pedal operated for hygiene reasons

  • Is there a mop, cleaning bucket and cleaning agents close by for spills management?

  • Are there adequate supplies of biohazard bags and disinfectant to clean up bodily fluid spills?

  • Is there a yellow spill kit for major bodily fluid spills as per CPAG Infection Control Procedure?

  • Is there suitable biological waste management and disposal in place that follows site procedure?

  • Is there adequate PPE for all CPA staff?

  • Is there adequate wet weather gear available for staff?

  • Is the furniture in the facility in good condition? Check for safety hazards such as sharp edges, broken wheels etc.

  • Are there toilets, hand washing facilities and clear running water?

  • Is there a shower for burns casualties and does the water run cool?

  • Is there a shower chair available?


  • Are electrical sockets, cables and appliances in good condition and working order and away from any water or other potential hazards?

  • Are all cables tagged?

  • Is there a reliable telephone system?

  • Is there a reliable radio system?

  • Is there a satellite phone?

  • Is there adequate and appropriate IT software and hardware?

  • Ask staff to show proficiency of use of common systems. Note any competency concerns.

  • Is there a telemedicine facility such as webcam or ability to take photos and email/text to doctor?

  • Do staff have access to a mobile phone with decent camera?

  • Is all electrical medical equipment in working order?

  • Request evidence of last biomedical maintenance and check report for any outstanding actions.

  • When was the last Biomedical Maintenance completed (must be within last 12 months)?

  • Have all issues been resolved?

  • What issues remain outstanding?

  • Question: Are there any concerns with medical equipment, batteries, cables or chargers?

  • Spot check: Check 3 items of electrical medical equipment - have they been calibrated/serviced in the past 12 months?

  • All items should be documented on an asset/equipment register and align with recent maintenance report. Add action item to update register if non-compliant.


  • Is there adequate wheelchair and stretcher access?

  • Is the facility easily accessible in general?

  • Are staff, contractors and visitors made aware of the facility during induction?

  • Are there relevant contact details on the external door of the facility and instructions explaining how to contact staff on duty if they are out of office?

  • Are they legible? ie. not faded, correct details.


  • Is the CP Medical Advisor contact information up to date and displayed prominently in the facility?

  • Are CP EAP service flyer and copy of current Poisons Approval displayed in the facility?

  • Is the current 2016 ARC ALS algorithm displayed prominently in the emergency treatment area of the facility?

  • Are the local/responding hospital emergency department and ambulance numbers known and displayed or stored in clinic mobile phone?

Ambulance - if no ambulance the equipment listed in this section must still be available on site

  • Is there an ambulance on site?

  • Is the ambulance within its service requirements?

  • Is a daily vehicle inspection performed using a checklist?

  • Is the vehicle equipped to deal with terrain safely?

  • Is the vehicle fully site compliant?

  • Is the vehicle clean and tidy?

  • Is there radio communication installed in the vehicle? Is it operational?

  • Is the stretcher operational?

  • Is there easy access for the stretcher in and out of the ambulance?

  • Are there adequate oxygen supplies?

  • Is oxygen stored correctly, with flowmeters biomedically checked in last 12 months?

  • Oxygen cylinders over half full?

  • Oxygen resus kit including airway kit (NGA,OPA,iGels) available and fully stocked, within expiry dates

  • Suction available? Portable unit acceptable

  • Are perishable items stored in the ambulance?

  • Confirm that no medications ever stored in ambulance?

  • Adequate ventilation and temperature control?

  • Ask staff to explain the procedure involved in responding to an emergency in the Ambulance.

  • Are directions and contact details for the receiving facility kept inside the ambulance?

  • Traction splint (CT-6 preferred)

  • Spinal board

  • Scoop Stretcher

  • Straps for stretchers

  • Soft collars/head blocks

  • KED

  • Pelvic Splint (Prometheus) or Sam pelvic splints in 2 sizes

Medical Equipment

Emergency Management - Airway kit is assessed in Ambulance Section

  • Is the emergency/treatment room set up to handle a minimum of 1 emergency/critical patient?

  • Is all emergency equipment online and connected to power or otherwise?

  • Is the response bag equipped to CPAG equipment levels?

  • Is a laminated copy of response bag contents list kept in the bag?

  • All equipment in date and evidence of regular checks performed (daily/weekly)?

  • If crash trolley is present, is it equipped for emergency airway, trauma and cannulation?

  • Chest Decompression Kit (Pneumodart or equivalent)

  • IO access equipment with instructions?

  • Adequate oxygen supplies for the facility?

  • Is oxygen stored in accordance with CP Operating Procedures?

  • Are all cylinders over half full?

  • Are regulators and flow meters within their biomedical maintenance schedule?

  • Is there portable suction available? (manual suction should be back up only)

  • Is there access to an additional AED/manual /semi?

  • Are there 3 sizes of iGEL (LMA's acceptable) present? (plus lube, tape, laryngoscope with batteries)

  • Is there mass casualty equipment available and stored in an organised fashion?

  • Triage cards or system?

  • Is all medical equipment within it's biomedical maintenance schedule?

  • Are treatment beds in good working condition?

  • Is there a maintenance schedule for the beds in the facility?

  • 360 degree access available to allow for airway management?

  • Slide board/sheets available?

  • Question: What is your process for evacuation with regard to equipment and drugs in the event of an emergency?

Locate item and check for maintenance, working condition, spare batteries present, adequate consumables, calibration date etc.

  • Thermometer

  • Sphygmomanometer

  • Pulse Oximeter

  • Stethoscope

  • Opthalmoscope (not essential)

  • Otoscope

  • BeBird ear camera

  • UV black light and fluorets or fluorescein

  • Eye Chart

  • Laryngoscope (operational with spare batteries)

  • Scales and height measure

  • Urinalysis dip sticks capable of detecting blood

  • Pregnancy test kits

  • 12 Lead ECG/Defib with ETCO2/NIBP/SaO2/pacing

  • Spirometer/Peak Flow (not essential)

  • Audiometer/booth (check ear muffs are in good condition)

  • Glucometer

  • Refractometer or other method for measuring urine SG

  • Pneumodart decompression needle or equivalent

  • Is a daily check performed on all emergency equipment to ensure all medical equipment is located and in working order?

  • Is a weekly check performed on all non-emergency equipment to ensure all medical equipment is located and in working order?

  • Request evidence of last daily and weekly check and note any outstanding actions here.

  • Are there any suggestions from staff that could improve equipment on site?


Locate each item and check expiry/condition

  • Syringes, needles and sterile swabs

  • Adequate supply of IV fluids (5L of N/saline minimum)

  • Splints (Sam and/or cardboard)

Medical Records

  • Are NWR amd WR records separated for confidentiality purposes?

  • Is the client denied access to all NWR information, unless with express worker consent?

  • Are electronic medical records kept on site?

  • Are paper records kept in secure locked cabinet with access only by medical staff?

  • Do non-medical personnel have access to these records?

  • Are medical records non-editable after consultation notes are saved?

First Aid Kits

First Aid Kits

  • Do CPAG staff perform first aid kit checks at the facility?

  • Is the first aid kit register up to date?

  • Spot check: Request to view the first aid register, is it accurate?

  • Check one first aid kit, are contents in line with best practice model?

  • Are all contents in date?

  • If contents are not in date, are they on order? Request evidence of stock order.

  • Is first aid signage adequate and visible from a distance?

  • When is the next first aid kit check due?

First Aid Training

  • Do CPAG staff provide first aid or other training on site?

  • Are CPAG trainers registered with Baseline Training?

  • Are there any improvements staff would like to see made to the Provide First Aid training program?

  • Is First Aid training equipment in good condition? Is there enough equipment?

Injury Management

  • Is RTW co-ordination conducted by CPAG staff?

  • Provide evidence of Injury Management certification for each staff member at the facility

  • In the past year have all RTW cases been managed without adverse incident?

  • Give an example of how current RTW cases are being managed in accordance with best practice.

  • Does the client have any concerns with the current injury management process in relation to CPA group staff involvement?


Client Related Competencies

  • Have all staff completed the full client induction?

  • Please detail any outstanding internal competencies that are overdue:

  • Are client related competencies detailed within a training matrix of some kind?

  • Is the training matrix current and accessible?

Qualification Requirements

  • Are all staff registered with AHPRA (Nurses and Paramedics)?

  • Do all medical staff hold current ACLS or ALS certification

  • Do all staff hold current CPA Authority to Practice certificate

  • Please detail any outstanding qualifications which do not meet contract requirements:

  • Are all qualifications documented accurately and up to date on training matrix?

  • Review the training matrix or electronic competency system to ensure all staff qualifications are current.

  • Question for staff: Please list any training you have completed in the past 6 months contributing to your continuous professional development.

  • Is the staff member compliant with legislative CPD requirements?

  • Question for staff: Is there any additional training you can think of that would benefit you in this role?

Medications - Please use separate Poisons audit. Complete this section only if vaccine fridge used


  • Is there a vaccine/medication fridge at the facility?

  • Make and model of fridge:

  • Who is responsible for the management of the fridge? Who is the back up person responsible?

  • Is there a temperature log/chart showing min/max temperatures?

  • Has this chart been completed daily?

  • Have all temperature discrepancies been reported and documented as per the Cold Chain Breach Procedure?

  • Is the medication fridge free of any malfunction (eg. poor seals, missing foot)?

  • Is there an appropriate gap between each medication/vaccine and the walls of the refrigerator?

  • Can the fridge continue to safely store the volume of vaccines/medication according to the guidelines? If no, what action has been taken? (This includes times of increased demand such as the influenza program)

  • If the fridge has a solid door is there a map/guide to where vaccines and medications are stored within it located on the door?

  • Does the power supply have a "do not disconnect" sign?

  • Is there a power supply contingency plan or generator?

  • If alternative storage is required in the event of a power failure, is it readily available with ice bricks and insulation?

  • Is the thermometer probe correctly placed within the fridge

Other Processes

  • If drug & alcohol testing is performed on site, is this policy accessible by staff?

  • Is the CPAG Infection Control Procedure accessible to staff?

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.