• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pre check

  • Provider number obtained? Please confirm the provider number is consistent with hicaps receipt in store?

  • Is the Optom an employee?

  • If they are not an employee, ie a loccum or contractor, have they been so for less than 14 days?

  • Have all employees completed their PCI and BEP modules?


  • Was an emergency contact list and evacuation plan available on request?

  • Is there a visitor contractor log?

  • We're safety processes visible for machines in the lab? Ie the lens shaver contained safety mechanisms.<br><br>

  • Was a fire extinguisher visible?. Was it in date?

  • Was the store wheelchair accessible, with slip proof flooring?

  • Was cctv in store? We're warning signs present?

  • We're manuals and procedures up to date?


  • Was the cash draw lockable?

  • Physical security risk profile. Was their restricted access to back off and desk areas?


  • Did all sunglasses have Australian standard swing tags/stickers?

  • Was all stock secure?

Employee observations

  • We're employees friendly and well presented?

  • Was the store clean and tidy, free of hazards?

Business systems?

  • Are all client notes on optimate? No paper based records retained?

  • When questioned, did employees dispose of job cards securely?


  • Was POS, appropriate and current?


  • Does The optom administer scheduled medicines? If so include photo of drug storage and location. If yes are they stored non a fridge, separate from food stuffs?

  • Are they disposed of at a chemist or acceptable medical waste disposal unit?

Data security

  • Record hicaps machine model and serial number

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.