Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Are all surfaces clean & clear of clutter?

  • X-ray unit - wall mount arm & head free from dust & debris?

  • Is the surgery free of cup, food & drink (other than bottled water with cap)

  • Are all shelves, ledges & windowsills free of dust & debris? <br>

  • Are all surfaces including the dental chair & bracket table free from bodily fluids & splatter?

  • Are all instruments bagged & correctly dated.?

  • Is all equipment and instruments stored correctly in cupboards & drawers?

  • Is the amalgamator clean and the surface around clear of dust & debris?

  • Is the surgery sufficiently stocked with essentials for the next session? (Water, gloves, bibs, cotton wool roll cups etc)

  • Are all bins tidy and not overflowing?

  • Is all decontamination equipment clean and ready for next session (ultra sonic, autoclave & washer) <br>

  • Are all xrays present = 2x size 2 1x size 1

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.