RDHM Environment Cleaning Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Chair

• Top surface and base of chair

  Yes

  No

  N/A

• Behind headrest and adjustment knob

  Yes

  No

  N/A

• Side panels

  Yes

  No

  N/A

• Under arm rest

  Yes

  No

  N/A

Bracket table

• Under tray and rim

  Yes

  No

  N/A

• Side handles

  Yes

  No

  N/A

• Top surface

  Yes

  No

  N/A

Switch panel

• Below switch panel and buttons

  Yes

  No

  N/A

• Bottom surface

  Yes

  No

  N/A

• Top surface

  Yes

  No

  N/A

Hand piece Bracket

• Outer surface

  Yes

  No

  N/A

• Hand piece cradle, buttons, and groves around buttons

  Yes

  No

  N/A

• Hand piece tubing and inner coupling grooves

  Yes

  No

  N/A

Light

• Arm

  Yes

  No

  N/A

• Light cover and switch

  Yes

  No

  N/A

• Handles

  Yes

  No

  N/A

Bench Tops

• Clean area

  Yes

  No

  N/A

• Contaminated area

  Yes

  No

  N/A

• Clerical area

  Yes

  No

  N/A

Suction Bracket

• Outer surfaces

  Yes

  No

  N/A

• Underneath

  Yes

  No

  N/A

• Hand piece cradle, buttons, and inner rim of buttons

  Yes

  No

  N/A

• Hand piece tubing - wiping the entire tube

  Yes

  No

  N/A

Cuspidor

• Inner bowl & upper ridge includes water- activator buttons

  Yes

  No

  N/A

• Spittoon filter and inner rim

  Yes

  No

  N/A

X-ray Unit

• Cone

  Yes

  No

  N/A

• Head

  Yes

  No

  N/A

• Arm

  Yes

  No

  N/A

• Outer trigger button and inner control pad

  Yes

  No

  N/A