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
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
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
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
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
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
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
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
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
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
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
Dental Management Solution Screen Recording
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