• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Top surface

  • Behind headrest

  • Side panels

  • Under arm rest

Bracket table

  • Under tray and rim

  • Side edge

  • Top surface

Switch panel

  • Below switch panel

  • Bottom surface

  • Top surface

Hand piece Bracket

  • Outer surface

  • Hand piece cradle and buttons

  • Hand piece tubing


  • Arm

  • Light cover and switch

  • Handles

Bench Tops

  • Clean area

  • Contaminated area

  • Clerical area

Suction Bracket

  • Outer surfaces

  • Underneath

  • Hand piece cradle and buttons

  • Hand piece tubing


  • Inner bowl & upper ridge

  • Suction filter

X-ray Unit

  • Cone

  • Head

  • Arm

  • Trigger Button

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.