Dental Emergency Preparedness Checklist: Safety & Protocols

Ensure your dental practice is ready for anything! Our Dental Emergency Preparedness Checklist provides a step-by-step guide to safety protocols, equipment checks, and staff training-protecting your patients and team in any crisis. Download now for peace of mind.

This Template was installed 4 times.

Emergency Contact Information

1 of 10

Verify emergency contact details for patients and staff are readily available and updated.

Patient Full Name

Patient Medical History Summary

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Patient

Additional Contact Information/Notes

Medical Emergency Response

2 of 10

Outline procedures for handling medical emergencies (e.g., heart attack, stroke, allergic reaction).

Patient's Pulse Rate (BPM)

Patient's Blood Pressure (Systolic/Diastolic)

Patient's Level of Consciousness (LOC)

Brief Description of Emergency Situation

Date of Incident

Time of Incident

Administered Medication (if any)

Fire Safety & Evacuation

3 of 10

Ensure fire extinguishers are inspected, evacuation routes are clear, and drills are conducted.

Last Fire Extinguisher Inspection Date

Fire Extinguisher ABC Rating (e.g., 2.5 lbs)

Fire Alarm System Status

Evacuation Route Obstructions

Notes on Evacuation Route Obstructions

Last Fire Drill Date

Time of Last Fire Drill

Natural Disaster Preparedness

4 of 10

Address procedures for earthquakes, floods, or other natural disasters specific to the geographic location.

Estimated Flood Zone Elevation

Last Earthquake Drill Date

Designated Evacuation Assembly Point

Specific Instructions for Earthquake Procedure

Potential Disaster Threats (Select all that apply)

Map of Evacuation Routes

Estimated time to secure building during disaster warning

Power Outage Protocol

5 of 10

Establish protocols for handling power outages, including backup power systems and emergency lighting.

Generator Fuel Level (Gallons)

Last Generator Test Time

Generator Status

Date of Last Generator Service

Notes Regarding Generator Performance/Issues

Emergency Lighting Functionality

Oxygen & CPR Equipment

6 of 10

Check oxygen levels, expiration dates on supplies, and confirm CPR certification for designated staff.

Oxygen Tank Pressure (PSI)

Last Oxygen Tank Inspection Date

Flow Meter Calibration (LPM)

Expiration Date - Nasal Cannula

Expiration Date - Face Mask with Oxygen Port

CPR Certification Status - Staff Member 1 (e.g., Current, Expired, Not Certified)

AED Pad Expiration Date Checked?

AED Battery Voltage (V)

Hazardous Materials Management

7 of 10

Ensure proper storage, labeling, and disposal of hazardous materials (e.g., nitrous oxide, mercury).

Nitrous Oxide Cylinder Pressure (PSI)

Last Mercury Spill Kit Inspection Date

Mercury Spill Kit Availability

Notes on Current Hazardous Material Storage Conditions

Amalgam Waste Disposal Method

Photos of Hazardous Material Storage Area

Security & Active Shooter Response

8 of 10

Implement security measures and training for responding to potential threats and active shooter situations.

Security System Operational?

Door Locking Procedure Reviewed?

Brief Description of Security Personnel (if applicable)

Date of Last Security Drill/Training

Security Measures in Place:

Brief Summary of Active Shooter Response Protocol

Staff Trained in Active Shooter Response?

Communication & Notification

9 of 10

Define communication protocols for internal staff and external emergency services.

Emergency Contact Phone Numbers (Primary)

Emergency Contact Phone Numbers (Secondary)

Primary Communication Method (Staff)

Emergency Service Notification Method

Last Communication Plan Review Date

Detailed Communication Protocol (Staff and External Parties)

Staff Members Responsible for Communication

Regular Review & Updates

10 of 10

Schedule periodic reviews and updates to the emergency preparedness checklist.

Last Review Date

Review Frequency (Months)

Summary of Changes Made

Review Trigger (e.g., incident, regulatory change)

Supporting Documentation (e.g., meeting minutes)

Review Status

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