Compliance form checklist
Gx1
What does this form include?
This form contains 19 sections:
Practice Name
Auditor / Compliance Manager
Cluster Manager
PM Name
Date of first visit Date
Date of update visit/next visit Date
Practice Appearance & Patient Journey
- Disability access appropriate / free from blockages / pathway clear and even
- NHS Charges posters clearly displayed and up to date
- Private fee scale clearly displayed
- Complaints procedure clearly displayed and up to date
- NHS paperwork in use (FP17PR, FP17DC) and MH forms being updated rather than new for each patient
- Patient records available (duplicates not in use)
Staff
- Uniform clean and presentable
- Name badges worn/identification of team role
- Emergency drugs checked daily (time/date and signatures -2 checks inc. one clinician)
- Check contents against list-all present /in date
- Oxygen cylinders full (gauge in green)
- Therapeutic/BVM masks available in adult/child sizes
- DE Fib light green (Rescue Ready) or equivalent
- Pocket masks in each surgery and visible
- Training record of CPR with attendance list
Health & Safety - Radiation check
- Signage
- Use of rectangular collimators
- Procedural checks - patient
- Panels seen during exposure
- Local rules and Risk Assessment
Health & Safety - Sharps Avoidance
- Risk Assessment completed
- Use of re-sheathing device in absence of "safer sharp"
- Dentists managing sharps
- Occupational Health Advice notice clearly displayed
- Staff awareness of process
Fire Safety
- Fire exits clear
- Fire doors unlocked
Practice Audits
- IPS tool completed within last 6/12 (PM)
- Radiation audits seen at least 12/12 (Dentists)
- Record keeping audit in last 6/12 (PM)
- DBOH audit by dentist within 12/12 (Dentists)
- Referral audit by PM within 6/12 (PM)
- Prescription audit by PM within 6/12 (PM)
- Recalls interval audit within 6/12 (Dentist)
- Waiting times audit 6/12 (PM)
Missing Signage/ Certificates/ Leaflets
Cross Infection & Decontamination
- Decon log books completed appropriately
- Observation of procedure
- Staff awareness of process
- Clinical waste appropriately stored
- Sharps disposal appropriate (container/contents/position)
Clinical Records checked against FGDP (UK) Gold Standard
- Radiographs in line with FGDP (UK) guidelines
- Treatment planning and delivery meeting including choices
- Private treatment
- Claiming pattern
- Laboratory issues
- Complaints
- Communication
I fully understand the audit as completed the auditor.
Practice Manager / Asst Practice Manager
Auditor
Use this template