TECHNICAL AUDIT

  • Document No.

  • Audit Title

  • Clinic Name

  • Clinic Number

  • Conducted on

  • Prepared by

WATER TREATMENT

  • Date & Time Audit commenced

  • Clinic Name

  • Clinic Number

  • Address
  • Phone No.

  • Head Nurses Name

  • Head Nurses Email

  • Operation Managers Name

  • Operation Managers Email and Phone No.

  • Number of Dialysis Stations

  • Technical Services provided by (Company)-

  • Photo of the outside of the clinic

WTS SPECIFICATIONS

  • Brand of WTS

  • Make

  • Model

  • Year Installed

  • Is there a Accurate Flow diagram within the Plant Room

PRE-TREATMENT

  • Heavy Metal Raw Water Analysis undertaken in last 12 months

  • Does Pre-Treatment comply with ISO Standard

  • Are there 2 Carbon Filters

  • Are Carbon filter(s) correct size (EBCT-Empty Bed Contact Time) for number of Dialysis Stations

  • Is there a sampling port Post Carbon Filter One

  • Is there a sampling port Post Carbon Filter Two

  • Is there a sampling port Post Softener Column

  • Brine tank is clean inside

  • Correct salt in use (Vacuum Salt Tablets=Best Practice)

  • Brine tank - is un-dissolved salt visible

  • Salt stored correctly (I.e. not on floor)

  • Does the media/sand filter controller work

  • Does the Water Softener controller work

  • Has the resin in the softener been replaced in the last 5 years?

  • Does the Carbon filter 1 controller work?

  • Has the Carbon Media in Carbon Filter 1 been replaced in the last 2 years?

  • Does the Carbon filter 2 controller work

  • Has the Carbon Media in Carbon Filter 2 been replaced in the last 2 years?

  • Pressure Pre/Post Sand/Media Filter

  • Pressure Pre/Post Carbon Filter 1

  • Pressure Pre/Post Carbon Filter 2

  • Pressure Pre/Post Water Softener

  • Pressure Pre/Post Cartridge Filters

  • Pretreatment equipment clean & in good repair

  • Photo of Pre-Treatment

REVERSE OSMOSIS SYSTEM

  • Has RO System been Certified for use in Dialysis

  • Heavy metal dialysis water test annually

  • Audible/Visual alarm on RO - if dialysis water unsafe

  • Is there a nurse panel with Audible/Visual alarm on RO - if dialysis water unsafe

  • Electrical safety test on RO in last 12 months

  • Is there an RO Equipment Manual readily available

  • Is there a service Register/Report for RO

  • Have the RO Membranes been replaced in the last 5 years?

  • Has RO been Disinfected in last 6 Months

  • Reverse Osmosis clean & in good repair

  • Photo of Reverse Osmosis System

REVERSE OSMOSIS MONITORING EQUIPMENT

  • Pressure gauge pre-membranes

  • Pressure gauge post membrane

  • Raw Water Conductivity Display

  • Dialysis Water Conductivity Display

  • Rejection Display

  • Dialysis Water Conductivity Alarm

  • Rejection Alarm

  • Flow Meters

DISTRIBUTION SYSTEM

  • What type of Distribution System is installed

  • Is there a readily available Manual for Distribution System

  • Is there a Service Report/Register for the Distribution loop

  • NO bladder tanks in Loop System

  • Is RO Storage Tank bottom conical in shape

  • 6 monthly Disinfection undertaken

  • UV light in the Reverse Osmosis Tank

  • UV lamp changed yearly

  • Is there 0.45 Micron Vent Filter

  • Cartridge Filter (1micron) in place after UV Light

STAFF WTS TESTING OBSERVATIONS

  • Staff wear full PPE for CFU/Endotoxins Testing

  • Did staff member demonstrate the correct Port for CFU/Endotoxins Sampling

  • Staff observed to clean port with alcohol wipe pre testing for CFU & Endotoxin sampling

  • Was sampling port turned on & running for Approx 2 Litres

  • Was tap turned off after sampling container sealed

  • Was Total Chlorine test performed correctly

  • Was Water Hardness performed correctly

DIRECTIVES & DOCUMENTATION

  • Documented policy on WTS Testing

  • Documented Work Instruction - Detailed instructions on how to undertake WTS tests

  • Is there a record book/ folder with all WTS Testing Results

  • Is there a record of Staff WTS Training

GENERAL COMMENTS ON WATER TREATMENT SYSTEM AND PRACTICES

  • Comments

  • General Water Equipment Photos

HD MACHINES

HD MACHINES

  • HD MACHINES ~ No. - MAKE - MODEL - AGE

  • Is there an Operators Manual for each HD Machine in the Clinic

  • 4008NG & 5008 preventative maintenance undertaken each 2 Years

  • All prior to the above FMC HD Machine models Preventative Maintenance Annually

  • All other company HD Machines preventative Maintenance as per Manual

  • Record of Maintenance in Clinic

  • HD Machine mechanical condition is safe for use

  • Exterior casing in good condition

  • Rust not present on any part of machine

  • Power Cord Not Damaged

  • Machine is clean

  • Dialysis Water entry hose is Opaque

  • Dialysis Waste hose is Opaque

  • Annual Electrical Safety Test undertaken on every machine(EST)

  • Dust filter is clean (should be cleaned weekly)

DIALYSIS FLUID ULTRA FILTER

  • Filter installed on all machines (e.g. FMC machines Diasafe, Gambro U9000)

  • Filter changed every - 100 treatments, 11 degreasing Bleaches OR 3 months

  • Filter labelled with date of last change

LABELS ~ HD MACHINES

  • Machine has an ID Label

  • Machine has a warning label

  • Machine has an information label

  • Machine has a safety test (EST) label

WATER CONNECTORS

  • Machine WTS Connector is installed on external Media Panel not inside a cupboard

  • Does drainage have Air Gap

PORTABLE RO

PORTABLE RO

  • Number - Make - Model - Age

  • Maintenance undertaken as per Manufacturers recommendation

  • Records of all maintenance kept In Clinic

  • Operators manual for every Portable RO

  • Is Portable RO clean

  • Annual Electrical Safety Test (EST) undertaken

PORTABLE WTS DISINFECTION

  • Disinfection undertaken every Month (BEST PRACTICE)

  • Disinfection undertaken every 3 Months

  • Disinfection undertaken every 6 Months

  • Disinfection undertaken every 12 Months

  • Documentation of disinfection available in Clinic

PORTABLE WTS PRE FILTRATION

  • Carbon Cartridges replacement

  • Media Cartridge

  • Softener in place

  • Carbon Filter

  • Cartridge Media Filter

  • Is the amount of Carbon adequate (10 EBCT)

  • Carbon Media replacement

PORTABLE WTS WATER TESTING

  • Testing for CFU & Endotoxins undertaken every 3 months

  • Records of Results available in Clinic

  • Photo of Equipment

WEIGHING SCALES

WEIGHING SCALES

  • Number - Make - Model - Age

  • Maintenance undertaken as per Manufacturers recommendation

  • Records of all maintenance kept In Clinic

  • Operators manual

  • Annual Electrical Safety Test (EST) undertaken

Reprocessoring Equipment

Reprocessing Equipment

  • Model, number, age

  • Maintenance undertaken as per manufacturers instructions?

  • Records of service?

  • Records of Dialyser reprocessing?

  • Equipment operating manuals?

  • Annual Electrical Safety Test (EST) performed?

  • Is the reprocessing room well ventilated?

  • Is there Material Safety Data Sheet (MSDS) in the reprocessing room?

  • Is there Personnel Protection Equipment (PPE) available for staff?

  • Are the staff using PPE during reprocessing?

  • Photos of reprocessing room and equipment.

Concentrate Mixing

Concentrate Mixing

  • Manufacture, Model, Age

  • Is the Room Clean?

  • Is the Equipment Clean?

  • Is the Room Ventilated?

  • Are MSDS Information readily available for all chemicals?

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.