INSTRUCTION FOR SYSTEMS AUDITOR: Check “YES” if the following are present and meet the expectations of CLD standards in the clinic. Check “NO” if the following are not present and did not meet the expectations of CLD standards in the clinic. Check “N/A” if not applicable. Add any observations in the “REMARKS”. Make sure to ask at least a DOM or ADOM of the following questions. Take pictures of all violations.
×
Scan this QR code to use this paper checklist on your smartphone or tablet or visit https://safetyculture.com/
Title Page
Site conducted
Conducted on
Prepared by
Clinic Door
CLD Logo
Office hour sign
Patient Waiting Area
Chairs in the waiting area
TV turned on: CLD Patient Education Video (verify the monthly deal flyer)
Cleanliness: <br>- Clean floor
Trash bin
Untitled Page
*Pending* Clinic Walkthrough
INSTRUCTION FOR SYSTEMS AUDITOR: Check “YES” if the following are present and meet the expectations of CLD standards in the clinic. Check “NO” if the following are not present and did not meet the expectations of CLD standards in the clinic. Check “N/A” if not applicable. Add any observations in the “REMARKS”. Make sure to ask at least a DOM or ADOM of the following questions. Take pictures of all violations.
©SafetyCulture 2022