Dental Office Checklist Template: Compliance & Patient Safety

Ensure your dental practice is compliant and patient-focused! This comprehensive checklist template covers essential protocols for infection control, OSHA regulations, patient safety, and more. Streamline your operations, minimize risk, and deliver exceptional care with our customizable Dental Office Checklist Template. Download now and protect your practice!

This Template was installed 4 times.

Infection Control & Sterilization

1 of 10

Ensuring proper sterilization and infection control protocols are followed to prevent cross-contamination.

Last Autoclave Validation Date

Autoclave Cycle Count

Surface Disinfectant Used

Areas Disinfected Today

Notes on Sterilization Process (if applicable)

Type of Ultrasonic Scaler Used

Autoclave Temperature & Pressure Log (Optional)

Patient Safety Protocols

2 of 10

Verification of procedures to minimize patient risk and ensure a safe environment.

Patient Weight (lbs)

Patient Height (inches)

Patient Medical History Review Completed?

Allergies Noted & Verified?

Emergency Contact Information Verified?

Last Patient Safety Training Date

Patient Safety Concerns Addressed?

Clinician Signature - Patient Safety Verification

HIPAA Compliance

3 of 10

Checks to maintain patient privacy and adherence to HIPAA regulations.

Date of Last Privacy Rule Training

Summary of Privacy Policies Communicated to Patients

Method of Patient Consent for Data Sharing (Electronic/Paper)

Types of Protected Health Information (PHI) Accessed

Date of Last HIPAA Risk Assessment

Method for Securely Transmitting PHI (e.g., encrypted email, secure portal)

Summary of Breach Response Plan

OSHA Compliance

4 of 10

Ensuring adherence to Occupational Safety and Health Administration standards.

Last eyewash station inspection date

Date of last bloodborne pathogens training

SDS (Safety Data Sheets) are readily accessible?

Which PPE (Personal Protective Equipment) is readily available?

Sharps containers properly labeled and accessible?

Notes on any OSHA-related observations or corrective actions needed

Date of next scheduled OSHA compliance review

Emergency Preparedness

5 of 10

Validation of protocols and resources for handling medical emergencies and disasters.

Last Emergency Drill Date

Time of Last Emergency Drill

Brief Description of Drill Scenario

Number of Staff Participating in Drill

Emergency Contacts Verified?

Emergency Contact List (Current)

Description of Corrective Actions (If any) following last drill

Evacuation Route Marked?

Location of First Aid Kit

Equipment Maintenance & Calibration

6 of 10

Confirmation of routine maintenance and calibration of dental equipment.

Last Autoclave Maintenance Date

Autoclave Cycle Count (for each cycle)

Water Tank Temperature (°C)

X-Ray Machine Calibration Status

Last Ultrasonic Scaler Inspection Date

Notes on any Equipment Issues

Calibration Certificates (Upload)

Medication Management

7 of 10

Verification of proper storage, handling, and dispensing of medications.

Last Controlled Substance Inventory Date

Quantity of Morphine Sulfate Available (units)

Controlled Substance Storage Method

Notes from Last Medication Audit (if applicable)

Date of Next Controlled Substance Inventory

Proper Disposal Method for Unused Medications

Signature of Person Responsible for Medication Management

Radiology Safety

8 of 10

Checks related to radiation safety protocols and equipment operation.

Last Radiation Safety Training Date

Patient Exposure Dose (mSv)

Shielding Adequacy (Patient & Staff)

Collimation Functionality

Equipment Calibration Records

Distance to X-Ray Source (cm)

Time of Last Equipment Check

Waste Management

9 of 10

Ensuring proper handling and disposal of regulated medical waste.

Last Waste Disposal Date

Number of Sharps Containers Used This Period

Quantity of Biohazard Waste Bags Used

Waste Disposal Company

Waste Types Generated

Notes/Comments on Waste Management Practices

Employee Training & Competency

10 of 10

Validation of employee training records and competency assessments.

Last Infection Control Training Date

Last HIPAA Compliance Training Date

Last Radation Safety Training Date

Infection Control Modules Covered (check all that apply)

Number of Continuing Education Credits Completed This Year

Proof of Completion - Continuing Education Certificates

Competency Assessment Status - Charting

Notes on any Training Deficiencies or Remediation Plans

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